Sleep disturbance associated with SSRI use in older women

A cross-sectional study of selective serotonin reuptake inhibitor (SSRI) use by community-dwelling older women aged ≥71 years with or without depression demonstrated that SSRI use in that population was strongly associated with sleep disturbance. The study, which relied on data collected from 4 centers throughout the United States, was recently published in the Journal of the American Geriatrics Society.

Depressive symptoms and depression have been related to sleep complaints in older individuals, perhaps due to other psychiatric/medical problems or medication effects. SSRIs are commonly prescribed antidepressants due to their perceived limited adverse effect profile. Studies have assessed overnight sleep electroencephalographic (EEG) recordings of SSRI users, and the agents' effects on sleep generally have been negative (eg, rapid-eye-movement [REM] suppression, prolongation of REM latency, poor sleep efficiency, and greater nighttime wakefulness).

The cohort of 10,336 women consisted of Caucasian and Black women from the Study of Osteoporotic Fractures (SOF). In the study sample, SSRI use was ascertained, evidence of depression was assessed via patient query, and objective measures of sleep were taken using wrist actigraphy for a minimum of 3 days and nights. All active surviving study participants (n=3,047) were asked to participate in an examination that included women who had complete actigraphy and medication information. After additional exclusions, the overall cohort included 2,853 women. A secondary analysis was performed in 2,337 women with a depression diagnosis or in those who scored ≥6 on a 15-item Geriatric Depression Scale (GDS)-a self-reported scale of 15 yes/no questions regarding depression symptoms, with 6 symptoms being the depression cutoff. The Goldberg anxiety scale also was used.

Patients kept a sleep log, and the following sleep parameters (average for all nights) also were examined: total sleep time per night; sleep efficiency; sleep latency; time awake after sleep onset; and long wake episodes (number of awakenings >5 minutes).

The mean age of the overall cohort was 83 years, with 8% (n=223) taking SSRIs and 2,630 not taking antidepressants. Of the nondepressed subcohort (n=2,337), 3% (n=69) were taking SSRIs and 2,268 were not taking antidepressants. The overall cohort had low total sleep time (9% with ≤5 hours sleep), sleep efficiency of <70% (21%), long sleep latency (≥1 hour), and high nighttime wakefulness (30% after sleep onset of ≥1.5 hours); 27% had ≥8 long wake episodes.

After adjustments for confounders, women taking SSRIs were more likely than those not receiving antidepressants to have sleep duration of ≤5 hours (multivariate OR=2.15; 95% CI, 1.04–4.47), sleep efficiency of <70% (multivariate OR=2.37; 95% CI, 1.32–4.25), sleep latency of ≥1 hour (multivariate OR=3.99; 95% CI, 2.29–6.96), and number of long wake episodes ≥8 (multivariate OR=1.75; 95% CI, 0.99–3.10); impaired sleep continued in the subcohort of nondepressed women. After adjustment for multiple potential confounders, women without a diagnosis of depression (SSRI users) on average still had impaired sleep. Average sleep time was similar between SSRI users and non-antidepressant users (P=.33).

Study limitations included lack of a control group and potential confounding by indication (SSRI use may be an indicator for depression, depressive symptoms, or anxiety, which itself can impair sleep). Additionally, extrapolation to other populations may be inaccurate, and self-reported parameters also may be inaccurate (eg, time out of bed).

SOURCE Ensrud KE, Blackwell TL, Ancoli-Israel S, et al; for the Study of Osteoporotic Fractures Research Group. Use of selective serotonin reuptake inhibitors and sleep disturbances in community-dwelling older women. J Am Geriatr Soc. 2006;54:1508–1515.