Drug effects on REM sleep and on endogenous depression

Renin as a biological marker of the NREM-REM sleep cycle: effect of REM sleep suppression

We have previously described that, in normal man, the nocturnal oscillations of plasma renin activity (PRA) exactly reflect the rapid eye movement (REM)-non(N)REM sleep cycles, with increasing PRA levels during NREM sleep and decreasing levels during REM sleep. This study was carried out to determine whether REM sleep suppression affects nocturnal renin profiles and to define which sleep stage is essential for renin release. In a first experimental series, REM sleep was suppressed by using clomipramine, a tricyclic antidepressant. Seven healthy young men were studied once during a night when a placebo was given and once during a night following a single dose of 50 mg clomipramine. Blood was collected every 10 min from 23.00 hours to 07.00 hours. PRA was measured by radio-immunoassay and the nocturnal profiles were analysed using the pulse detection program ULTRA. Clomipramine suppressed REM sleep in all subjects but one, but did not affect the number of SWS episodes nor their duration. Similar PRA profiles were observed in both experimental conditions. Neither the mean levels, nor the number and the amplitude of the oscillations were modified and the normal relationship between slow wave sleep and increasing PRA levels was preserved. In a second experimental series, REM sleep was prevented by rapidly awakening the subjects as soon as they fell into REM sleep. The four subjects studied attempted several times to go into REM sleep, but only when PRA levels were decreasing. The interruption of REM sleep by short waking periods did not disturb PRA for which the oscillations remained unaffected. Again, the relationship between SWS and increasing PRA levels was preserved. These results provide evidence that mechanisms increasing slow-wave activity are principally involved in increasing PRA levels and that replacing REM sleep by waking periods and light sleep does not modify nocturnal PRA oscillations.

Symposium: Normal and abnormal REM sleep regulation: REM sleep in successful, usual, and pathological aging: the Pittsburgh experience 1980-1993

Successful psychological and physical adaptation in late life correlates with preservation of sleep quality and physiological integrity of nocturnal EEG sleep measures. Failure to adapt is associated with loss of sleep continuity, alterations in the temporal distribution of delta wave activity, and by either a relative increase in REM sleep (e.g. in mood disorders) or a decrease in REM sleep (e.g. neurodegenerative disorders). Maintenance of sleep (particularly REM sleep) into late life may not be just a correlate, but also possibly a mechanism, of successful aging and thus necessary to the long-term maintenance of vitality and engagement in life.

[Sleep and biological rhythms in depression. Changes caused by antidepressants]

Sleep in depression is characterized by an increase in the number and duration of awakenings, sleep instability, and SWS decrease. REM sleep occurs earlier. REMs density during the 1st REM period is higher than in normal controls matched in age. Accordingly, sleep in depression is similar to sleep in normal aging. Endogenous depression cannot be distinguished from other types of depression by means of polygraphic criteria. Sleep recordings at the beginning of tricyclic compound treatment could be predictive of clinical response to treatment. Sleep modifications induced by antidepressive drugs are reviewed. Sleep recordings enabled us to formulate several physiopathological hypotheses of depression mechanisms: cholinergic-aminergic hypothesis, phase advance, deficiency of process S. Other hypotheses are reviewed: flattening of a hypothetical circadian rhythm of arousal, depressogenic property of sleep in itself (or only of SWS) or timing delay for the start of sleep. A significant phase advance of biological rhythms (temperature, cortisol) is rarely found. A reduction in the amplitude of rhythms (temperature, TSH, melatonine) is more frequent.

Changes in EEG power density of NREM sleep in depressed patients during treatment with citalopram

According to a recent hypothesis the therapeutic effects of antidepressants might be related to acute or cumulative suppression of NREM sleep intensity. This intensity has been proposed to be expressed in the EEG power density in NREM sleep. In the present study the relationship was examined between the changes of EEG power density in NREM sleep and the changes in clinical state in 16 depressed patients during treatment with citalopram, a highly specific serotonin uptake inhibitor. A one-week wash-out period was followed by 1 week of placebo administration, a medication period of 5 weeks, and a one-week placebo period. In order to minimize systematic influences of sleep duration and NREM-REM sleep alterations, EEG power was measured over the longest common amount of NREM sleep stages 2, 3 and 4 (91.5 min). During the last treatment week and the week after withdrawal, a significant decrease of EEG power as compared to baseline was found in the 8-9 Hz frequency range. No clear-cut change, however, was observed in the EEG power of the delta frequency range (1-4 Hz), which is considered to be the principle manifestation of NREMS intensity. Furthermore, no relationship between changes in EEG power density and changes in clinical state could be demonstrated.

Behavioral effects of neonatal treatment with clomipramine, scopolamine, and idazoxan in male rats

It has been suggested that REM sleep deprivation due to the administration of clomipramine, during early developmental stages, results in dramatic behavioral changes during adulthood. One of the main alterations is the impairment of masculine sexual behavior (MSB). Clomipramine increase monoaminergic availability at the synaptic level and also suppresses REM sleep. This study was performed to compare the effect on masculine sexual behavior of three different neonatal treatments: clomipramine, which increases monoaminergic availability at the synaptic level and suppresses REM sleep; scopolamine, a cholinergic antagonist that suppresses REM sleep; and idaxozan, a selective adrenergic agonist. Subjects (Ss) were treated neonatally and tested for masculine sexual behavior during adulthood with standard techniques. Results obtained with clomipramine administration showed a marked impairment of MSB, mainly reflected by the decrease in the percentage of active Ss and the decrease in the percentage of Ss reaching ejaculation. In contrast, idaxozan and scopolamine produce a facilitation of MSB. The effect of idaxozan was not significantly different when compared to saline control rats. The effect of scopolamine was greater, and the percentage of Ss reaching ejaculation was significantly larger than saline control. These results suggest that the alterations of sexual behavior induced with neonatally administered clomipramine are not due to early REM sleep deprivation. As idaxozan did not replicate clomipramine results, it is also possible that noradrenergic transmission is not involved in the generation of these effects. It remains possible that the serotonin system could be responsible for the impairment of sexual behavior due to neonatal clomipramine treatment.

Effect of rapid eye movement sleep deprivation on rat brain monoamine oxidases

Monoamine oxidase, monoamine oxidase-A, and monoamine oxidase-B activities were compared in free moving, rapid eye movement sleep-deprived, recovered, and control rat brains. The activities were estimated in the whole brain, cerebrum, cerebellum, whole brainstem, medulla, pons, and midbrain. The flowerpot method was used for continuing deprivation for one, two, or four days. Monoamine oxidase activity decreased significantly in the cerebrum and the cerebellum of the sleep-deprived rats, whereas monoamine oxidase-A and monoamine oxidase-B were differentially affected. Medullary MAO-A was the first to be affected, showing an increase after just one day of rapid eye movement sleep deprivation, while longer deprivation decreased its activity. The activity of monoamine oxidase-B was not significantly affected in any brain areas of the deprived rats until after two days of rapid eye movement sleep deprivation. All the altered enzyme activities returned to control levels after recovery. Control experiments suggest that the decrease was primarily caused by the rapid eye movement sleep deprivation and was not due to nonspecific effects. These findings are consistent with past studies and may help to explain earlier observations. The results support the involvement of aminergic mechanisms in rapid eye movement sleep. The plausible reasons for the changes in the activities of monoamine oxidases, after rapid eye movement sleep deprivation, are discussed.

Juvenile desipramine reduces adult sensitivity to imipramine in two behavioral tests

The behavioral effects of adult imipramine administration were examined in female rats treated with desipramine as juveniles (JDES), treated with saline as juveniles (JSAL), and untreated as juveniles (JUNT). In the forced swimming test, the juvenile groups displayed similar behavioral effects of imipramine when administered short term following a pretest forced swimming exposure. Similar effects of imipramine were observed when administered long term prior to the only test exposure. When rats were not given a pretest forced swimming test exposure, short-term imipramine had no effect on JDES rats but did influence JSAL and JUNT rats. In the open-field test, short- and long-term imipramine treatment affected the behavior of JUNT and JSAL rats. Short-term imipramine treatment influenced open-field behavior of JDES animals, but long-term imipramine treatment had no effect. These results suggest that JDES treatment may permanently alter the neural mechanism underlying the behavioral effects of antidepressant treatment.

Effects of chronic treatment with two selective 5-HT2 antagonists on sleep in the rat

The effect of chronic administration of 2(2-dimethylaminoethylthio)-3-phenylquinoline (ICI-169,369) and 2(2-dimethylamino-2-methylpropylthio)-3-phenylquinoline (ICI-170,809), two selective 5-HT2 antagonists, on sleep was studied in rats. As previously shown, the acute effect of ICI-170,809 was to increase latency to rapid eye movement sleep (REMS), decrease the number of REM periods (REMPs), suppress the cumulative amount of REMS over 12 h, and increase the duration of REMPs in the first 6 h, while having no effect on non-REM sleep (NREMS). Administration of ICI-169,369 had similar effects except no change was seen in the duration of REMPs and cumulative REMS was suppressed for 24 h. When given 2 x daily for 5 days, tolerance to the REMS suppressant effects developed in both drugs. After discontinuation of treatment, a REMS rebound occurred after ICI-170,809, but not ICI-169,369. No significant effect on NREMS was seen after administration of ICI-170,809, whereas ICI-169,369 lowered 24-h cumulative NREMS on the fifth day of administration.

Changes in sleep polygraphic variables and clinical state in depressed patients during treatment with citalopram

Drug-induced improvement of depression may be mediated by changes in sleep physiology. The aim of this study was to relate changes in sleep polygraphic variables to clinical state during treatment with citalopram, a highly specific serotonin uptake inhibitor. Sixteen patients took part. The study was single-blind and uncontrolled. A 1-week wash-out period was followed by 1 week of placebo administration, a medication period of 5 weeks, and a 1-week placebo period. For the entire group a significant decrease of rapid eye movement sleep (REMS) and a significant lengthening of REMS latency were observed initially as well as at the end of treatment. No changes in sleep continuity were found, but non-REMS stage 2 (percentage) was significantly increased. On the basis of clinical change, as expressed by the scores of the Hamilton Rating Scale for Depression, at the end of the citalopram treatment the patient group was split in two halves: eight less and eight more improved patients. The groups did not differ with respect to any sleep polygraphic variable.

Can non-REM sleep be depressogenic?

Sleep and mood are clearly interrelated in major depression, as shown by the antidepressive effects of various experiments, such as total sleep deprivation, partial sleep deprivation, REM sleep deprivation, and temporal shifts of the sleep period. The prevailing hypotheses explaining these effects concern the antidepressant potency of the suppression of either REM sleep or non-REM sleep. This issue is discussed in the light of present knowledge of the kinetics of non-REM sleep intensity, REM sleep production, and their interaction. Recent findings have led us to suggest that the suppression of non-REM sleep intensity is the common pathway in the set of experimental data on the antidepressant effects of sleep manipulations.

Effects of trazodone on EEG sleep and clinical state in major depression

The effects of the antidepressant trazodone on clinical state and on EEG sleep in eight outpatients with a major depressive disorder were investigated in a single blind study. A medication period of 5 weeks was preceded and followed by one week placebo treatment. Five subjects showed a positive treatment response. Trazodone did not influence sleep continuity and slow wave sleep, but did suppress REM sleep significantly. A significant increase of REM sleep latency was also found. These results are in contrast with earlier reports on trazodone's effects on EEG sleep but are in accordance with the general finding that antidepressants influence REM sleep characteristics without necessarily affecting sleep continuity.