Effect of nefazodone and lithium on sleep architecture in healthy men

Antidepressant drugs produce striking effects on sleep architecture which are best understood in terms of their interactions with the monoamine pathways controlling sleep and wakefulness. Sleep changes almost invariably include a reduction in the amount of rapid eye movement (REM) sleep in both healthy volunteers and depressed patients. Four studies were conducted in normal male volunteers to determine the effects of nefazodone, a new antidepressant with a dual mode of action - 5-HT2 receptor antagonism and moderate inhibition of serotonin re-uptake - on sleep architecture. Use of normal volunteers allowed interpretation of the effects in the absence of any interaction between the antidepressant drug and the abnormal sleep patterns characteristic of depression. From these studies it appears that, unlike most antidepressant treatments, nefazodone maintains or increases the amount of REM sleep. In addition, nefazodone improves sleep continuity without causing sedation. It is of interest that, in combination with lithium, nefazodone increases slow-wave sleep. The sleep profile of nefazodone appears to be distinct from that of TCAs and SSRIs.