Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression

Background Sleep effects of antidepressants are important clinically and for elucidating mechanism of action: selective serotonin reuptake inhibitors disturb sleep and 5-HT2 receptor-blocking compounds may enhance sleep quality. Aims To compare the objective and subjective effects on sleep of paroxetine and nefazodone in patients with moderate to severe depression. Method Forty patients with depression were randomised to take paroxetine 20-40 mg/day or nefazodone 400–600 mg/day for 8 weeks. Objective and subjective quality of sleep and depression measures were assessed throughout. Results Nefazodone significantly increased objective sleep efficiency and total sleep time, and improved subjective sleep on days 3 and 10. Paroxetine decreased sleep efficiency early in treatment and some sleep disruption remained at week 8. Paroxetine but not nefazodone produced marked suppression of rapid eye movement (REM) sleep. Conclusions Nefazodone improves sleep in early treatment compared with paroxetine in patients with moderate to severe depression. These effects are seen within the first 2 weeks of treatment and diminish thereafter.