SSRIs and apnea

[ChipsXJ]

Can someone clear up my understanding of this....I may be all wet on the issue.

As I understand it, SSRIs like Prozac, inhibit the uptake or using up of serotonin. And Prozac reduces REM (when serotonin is created) and can cause apnea.

Lack of Serotonin will make us sleepy/fatigued.

If the Prozac is reducing the REM and thus reducing the creation of more serotonin...........would you not eventually run out of serotonin if taking prozac?


Trying to decide if I want to call my doc and see about stopping the prozac. Could the prozac be what has been making me sleepy/tire/fatigued and also caused my apnea?

[Guest]

SSRI stands for Selective Serotonin Reuptake Inhibitor These drugs do not lower the amount of serotonin, they act to decrease its uptake so, in effect, there is more of it around. It is hypothesized that those with depression are so because they don't produce enough serotonin, a neurotransmitter.

[ChipsXJ]

The part that has me baffled a bit is that: SSRIs have been shown to produce immediate (40-85%) and sustained (30-50%) reductions in REM sleep. This effect often causes increased fatigue in patients who take large doses of antidepressants for extended periods of time.

Doesn't OSA also reduce REM?

So it would seem if one had OSA and was on Prozac........that REM could be almost zilch.............would it not be a good idea to stop the Prozac to regain that part of the REM too?

[Guest]

I guess it would depend on just how severe one's depression might be. Going without an antidepressant can be as deadly as going without CPAP.

[old64mb]

And Prozac reduces REM...and can cause apnea.

There's research (which I'm gathering you've read) showing that Prozac and other SSRIs reduce REM sleep.

However, those same studies have shown that those drugs reduce apnea-hypopnea events in non-REM sleep, so if anything they 'help' apnea rather than 'cause' it. There's a holy grail (or more likely a tilt at windmills) quest to find a miracle drug to replace RT as a treatment for OSA, so that's where much of the research stems from since these, believe it or not, are looked on as potentially helpful.

Difference pre- and post-CPAP is that your machine will assist you in getting through REM cycles (where apnea is most prevalent) without waking up constantly, meaning even if you have less REM time it's actually effective versus what it was before, which was non-existent.

Should you look at switching from Prozac? There's was a great LA Times article yesterday on a big study comparing antidepressants - http://www.latimes.com/features/health/ ... 5922.story - and the most relevant quote is "All the doctors interviewed agree that the best drug to combat depression is the one that works, which can vary from person to person." The science behind this is that brain chemistry isn't understood terribly well compared to other areas of the body - someone once told me many of these drugs act like shooting a bazooka at a fly - and on top of that varies dramatically from person to person. Thus, what works really well for one may not work at all for another.

Thus, you can and should certainly work with your doctor to find the most effective pharmacological treatment for all your conditions, including how OSA relates to why you're on Prozac.

If you've only been on your CPAP a week or so, though, it can take a while to get used to it and even if you ended up being right, I'd bet they'd tell you that it's way too early to start messing with your treatment plan until you see how the CPAP works independently. For the more subtle effects of CPAP therapy like hormonal balances, I've been told it can take 6 months before you start seeing real change.

Whatever you do, don't stop your Prozac or any other anti-depressant without your doctor's permission. Not that I'm suggesting that this is what you're thinking, but stopping any medication without permission isn't a good idea. Doing so with anti-depressants, however, can be outright dangerous.

[nobody]

I don't know if there is any connection between that drug and OSA, but reducing REM sleep (which prozac does do) will probably make you feel more tired.

[ozij]

SSRI's can cause sleep fragmentation which can lead to a person feeling tired.

Some doctors are not aware of the link between OSA and depression - google OSA +depression, and start reading.

Members of this forum have reported a decreasing need for anti-depressant medication like Prozac as their OSA has decreased.
O.

[roster]

My opinion, after much reading and talking to patients and doctors, is that there is a huge problem in the U.S. with doctors prescribing antidepressants and overlooking that the patients have OSA. This is what happened to me.

Once I started CPAP, I fired the psychiatrist, the mental health counselor, and the PCP. I also took all the antidepressants and sealed them up in a bag which I marked, "Failures". Now I can't imagine that I would every take another antidepressant or see a mental health counselor - as long as I am using CPAP!

Untreated sleep apnea often causes what is diagnosed as depression!

[rem810926]

I have been taking SSRIs for depression for 9 years. I never had problems sleeping until I started taking them. I was finally able to resolve my depression by learning other coping mechanisms. I was giving the all clear to stop taking my Prisitq and I am starting to feel much more alive and awake. I am quite convinced that the antidepressants were causing my sleep trouble; I still am extremely restless but once the drugs are completely out of my system I feel hopeful I will be back to normal.

[Julie]

You may feel great now relative to not being on the meds any more, but it doesn't mean you don't have apnea.... only a new sleep study can tell you that, so don't cut off your nose to spite your face.

[KarmanMonkey]

Prozac is a very old medication; there may be a different SSRI that doesn't have the same impact on your REM sleep, or there may be a different class of antidepressant (there are varieties that act on different neurotransmitters).

In the end, though, it's about results, right? Do you feel you get benefit from the medication? Have you been on it long enough, and at a dose where you'd expect to see benefit?

It's all about cost/benefit. Depression can dramatically interfere with sleep, just like sleep apnea can lead to symptoms of depression.

It's worth having a discussion about the benefits/cost of switching meds based on your concerns. I'd also be looking at lifestyle changes that will improve matters as well. A lot of what helps with sleep disorders can also help with depression. Small, sustainable changes to your physical activity (e.g. parking farther from work, taking an extra flight of stairs every day) can have a dramatic effect on both depression and sleep quality.

Meds are valuable, and an important part of recovery for a lot of folks with depression, but in my case at least, medication has only ever accounted for about 10% of my recovery. I use the analogy that meds is climbing gear when you're stuck at the bottom of a cliff. It won't get you out on its own, but it makes the climb easier.

[Hang Fire]

Prozac is a very old medication

and you are replying to a very old post - 7.5 years.

[Omne]

Prozac is a very old medication

and you are replying to a very old post - 7.5 years.

Apparently they haven't found the miracle drug yet.

This is like jumping ahead in time....

[Guest]

I started a CPAP last July, 2016. It worked great. I primarily had OSA. I have always had anxiety but not depression. A major life event occurred in December and I was given low dose Lexapro for depression. It was the only medication change. Since then, my central apneas have gone from 1 to 7 an hour. I rarely had central apneas before. The Lexapro is wonderful for the depression and anxiety. The CPAP stopped OSA, which went undiagnosed for years (I was having huge suffocation episodes at night and these have stopped).

This is awareness for those starting an SSRI like Lexapro. I don't know what the answer is.

[ChicagoGranny]

Since then, my central apneas have gone from 1 to 7 an hour.

Are you using Sleepyhead to analyze and optimize your CPAP therapy? With those kinds of numbers, it's very important to your health. https://sleep.tnet.com/resources/sleepyhead