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• W1608770211 abstract "To the Editor: Rapid eye movement (REM) sleep behavior disorder (RBD) is often seen in older patients and is characterized by a loss of normal skeletal muscle atonia during REM sleep.1, 2 As a result, the disease manifests as nocturnal motor activity consistent with the enactment of dream content, for example grabbing the bed partner in response to a dream about falling from a cliff. RBD often results in injury to the patient, bed partner, or both.1, 2 In perhaps up to two-thirds of cases, RBD is associated with neurodegenerative disorders, most notably the alpha-synucleinopathies (Parkinson's disease, Lewy body disease, multiple systems atrophy), often antedating other manifestations of these disorders by many years.1-4 Other cases seem to be idiopathic, although it has been suggested that various medications, notably selective serotonin reuptake inhibitors (SSRI) and other antidepressants, may commonly induce RBD.1, 4, 5 In spite of this assertion, there have been few supporting case reports.5, 6 The authors recently cared for a man who clearly developed RBD as a result of SSRI treatment; the use of the SSRI for posttraumatic stress disorder (PTSD) complicated the clinical picture. An 87-year-old male World War II veteran had been treated for PTSD with associated nightmares but no nocturnal motor activity with bupropion and lorazepam. Past medical history was significant only for essential hypertension. In 1998, after many years of treatment, sertraline was added because of increasing symptoms. Within 6 months of adding sertraline, the patient developed frequent nocturnal motor behavior consistent with the content of his dreams and nightmares, for example punching and choking his wife in the context of a dream about being in a fight. As a result, he and his wife had suffered lacerations and contusions. Other behaviors included running out of his bedroom or running into a window. Upon awakening, he was able to recall portions of the dreams but was unaware of the motor behaviors. Trials of temazepam, zolpidem, and trazodone were ineffective in improving these behaviors. Ultimately, a diagnosis of RBD was made based on the clinical presentation. Clonazepam 1 mg at bedtime was added, which resulted in a moderate decrease in the frequency of the nocturnal motor activity, from nightly to two or three times per week. After 3 months, sertraline was slowly tapered and discontinued, which resulted in a complete cessation of all nocturnal motor behavior. He remained free of nocturnal motor activity for 5 months, until sertraline was inadvertently restarted after the loss of his wife. Within 1 month of restarting sertraline, the nocturnal motor behavior returned. There has thus far been no evidence of dementia or of parkinsonism. This patient's clinical presentation was typical of RBD; unfortunately, his and his wife's injuries were also typical. It seems clear that his RBD was SSRI induced; it developed after sertraline was started, did not definitively improve until it was stopped, and recurred after it was inadvertently restarted, and there was no evidence of parkinsonism or dementia over the previous 12 years. Although there are few published cases of SSRI-induced overt RBD, increased electromyography activity during REM sleep has been demonstrated in patients taking SSRIs. (None of the patients were being treated for PTSD.)7 The relationship between RBD and PTSD is complex and not fully investigated. There is clinical and polysomnographic evidence of greater motor activity during REM sleep in patients with PTSD,8 and greater prevalence of RBD was noted in a cohort of patients with PTSD.9 SSRIs are effective for PTSD-related nightmares10 but may cause RBD, clonazepam is effective for RBD1, 2, 4 but not for PTSD-related nightmares,10 and RBD is not associated with the typical diurnal symptoms of PTSD. In spite of his long history of PTSD and related nightmares, this patient had never exhibited any significant motor activity during sleep until the SSRI was started. RBD is relatively common in geriatric practice and should be explored in any patient with nocturnal injuries or motor activity. RBD responds well to treatment, generally with clonazepam. Discontinuation of SSRIs or changing to a different class of antidepressant (if feasible) may also be a viable option for some patients. This material was previously presented as a poster at the Florida Medical Directors Association annual meeting, Orlando, Florida, October 2009. It has not been published or submitted for publication elsewhere. Conflict of Interest: None of the authors have any actual or potential financial, personal, or other conflict of interest pertinent to this work. Author Contributions: All of the authors contributed to the conceptualization of this work, literature review, letter preparation. and final approval. Sponsor's Role: There was no sponsorship of this work and no source of funding." @default.
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• W1608770211 date "2010-07-01" @default.
• W1608770211 modified "2023-09-27" @default.
• W1608770211 title "A CASE OF SELECTIVE SEROTONIN REUPTAKE INHIBITOR-INDUCED RAPID EYE MOVEMENT BEHAVIOR DISORDER" @default.
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• W1608770211 doi "https://doi.org/10.1111/j.1532-5415.2010.02947.x" @default.
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