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Dr. Bob is Robert Hsiung, MD,
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Posted by LostBoyinNCBecksDark on December 31, 2007, at 22:05:22
Adding a low dose of atypical anti-psychotic to an antidepressant is a somewhat common strategy for refractory depressives. While risky due to concerns about EPS and inducement of metabolic syndrome/diabetes, atypical anti-psychotics due tend to increase slow wave sleep. This increase in slow wave sleep can improve recovery rates for some refractory depressives.
"J Clin Psychiatry. 2005 Apr;66(4):450-4.
Olanzapine increases slow wave sleep and sleep continuity in SSRI-resistant depressed patients.
Sharpley AL, Attenburrow ME, Hafizi S, Cowen PJ.
University Department of Psychiatry, Warneford Hospital, Oxford, United Kingdom. ann.sharpley@psych.ox.ac.uk
OBJECTIVE: The atypical antipsychotic drug olanzapine has been employed as an augmentation treatment in depressed patients unresponsive to treatment with selective serotonin reuptake inhibitors (SSRIs). In healthy subjects, acute olanzapine administration increases sleep continuity and enhances slow wave sleep (SWS). The aim of the present study was to determine if the addition of olanzapine to SSRI treatment in depressed patients produced similar effects on sleep. METHOD: We measured the effect of open-label olanzapine addition (2.5 mg/day initially) on the polysomnograms of 12 patients referred from primary care sources who met DSM-IV criteria for major depressive disorder and who had had an unsatisfactory response to therapeutic doses of an SSRI. Patients were first enrolled in November 2001; final assessment occurred in November 2003. Sleep polysomnogram recordings were made on 3 occasions: before olanzapine addition, on the first night of olanzapine treatment, and after 3 weeks of olanzapine treatment. RESULTS: After the first night of olanzapine treatment and during the third week, subjects showed improvements in sleep efficiency (p < .001), subjective sleep quality (p < .05), and SWS (p < .01). Scores on the Hamilton Rating Scale for Depression fell significantly (p = .001), with the majority of the decrease being apparent after the first week of treatment. CONCLUSION: Olanzapine improves sleep continuity and increases SWS in patients receiving SSRI treatment. These effects are apparent after the first dose of olanzapine and are maintained for the next 3 weeks. The ability of olanzapine to increase SWS is probably attributable to 5-HT(2A/2C) receptor blockade, which has been identified as a relevant mechanism in the therapeutic effect of olanzapine in SSRI-resistant depressed patients."
Posted by linkadge on January 1, 2008, at 0:13:06
In reply to Zyprexa increases slow wave sleep in TRDepressives, posted by LostBoyinNCBecksDark on December 31, 2007, at 22:05:22
Interesting. The effect is purportedly due to 5-ht2a/c blockade. On this account, I would like to see the effects of valdoxine, the 5-ht2c antagonist + melatonin receptor agonist on slow wave sleep. Perhaps it can produce the same effect with less collateral. Cyproheptadine or mirtazapine might also produce the same effect.
Linkadge
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