Can antidepressants cause vivid dreams?

Within a few weeks of taking antidepressants, the fog of anxiety I'd been living with for years began to lift. Although my anxious thoughts hadn't disappeared, the constant feeling of dread started to ease and things seemed easier to deal with.

Taking sertraline, an SSRI, has made coping with an anxiety disorder easier. But I've also noticed something strange. At night, my dreams are more vivid, colourful and wild - and very different to my usual dreams about work and day-to-day life.

Intense dreams aren't a problem compared to the struggle of living with anxiety. But is there really a link between taking SSRI-type antidepressants and dreaming?

For those living with mental illness, antidepressants can be an invaluable lifeline - helping people do things we tend to take for granted, such as getting up in the morning and showering. But like all medications, antidepressants can have side effects.

"The dreams are wild and vivid. They feel real and when I wake up I can be a bit disorientated," says Emily*, 41, who takes fluoxetine for anxiety and depression.

"I have a lot of anxiety-based dreams anyway - losing things, being late, the door ringing and I am naked, not knowing the answer at school. But the SSRI dreams are more like films where there is loads going on and I can wake up tired after a big night."

Potential links

Although the topic hasn't been widely explored, researchers have begun to look at the potential links between antidepressants and dreaming. "Certain medications, such as SSRIs that are used to treat depression, can also impact on sleep quality and coming off medication (withdrawing) might affect your dreams," says Stephen Buckley, head of information at Mind.

In a 2013 report published in Sleep Medicine Reviews, Gotthard Tribl and his research team completed a systematic review that examined the impact of antidepressants on dream content in both depressed and non-depressed individuals. Out of all the studies that had been published over a period of 60 years, they found a total of 21 clinical studies and 25 case reports that were eligible for review.

The studies compared dream content across a spectrum of different antidepressants, including SSRIs and tricyclics, an older class of medications still used today. The research also explored the dream content of those taking or not taking an antidepressant.

A variety of methods were used to record dream content, including morning dream diaries, verbal reports upon forced awakening during REM sleep, and questionnaires.

SSRIs

Antidepressants belonging to the SSRI class, such as sertraline, fluoxetine and citalopram - as well as serotonin-norepinephrine reuptake inhibitors (SNRIs) - were found in the review to intensify dreams and increase how often people reported having nightmares.

Crucially, though, the study authors noted that there hasn't been much attention paid to dream content and our ability to remember dreams.

Neurotransmitters

What we do know is that antidepressants affect neurotransmitters, including serotonin, dopamine and norepinephrine. According to Dr Mark Silvert, consultant psychiatrist and medical director at The Blue Tree Clinic, the increased amount of neurotransmitters in the brain may be linked to changes to how we dream.

"No-one really knows for certain, but all these brain chemicals regulate thoughts and emotions, so it makes sense that by increasing them, even at night, dreams could become more intense and real," he explains. "Pleasurable dreams can seem more enjoyable and intense and vice versa, nightmares can seem more scary and vivid."

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Antidepressants and REM sleep

Another factor may be the potential impact of antidepressants on REM (rapid eye movement) sleep. Most dreams occur during this restorative phase of sleep, and it is thought to play a role in learning, memory and mood.

"There's evidence that SSRIs impact rapid eye movement (REM) sleep, which is when most dreams occur," says Dr Tom Pennybacker, a consultant psychiatrist and co-founder of My Online Therapy.

"It's interesting though because SSRIs are said to suppress REM. If this is the case, we'd expect people to have fewer dreams rather than more. But it's certainly the case that some people have very vivid dreams while taking SSRIs - which can be positive or sometimes really vivid, nasty nightmares."

However, it's also important to note that mental health problems such as anxiety and depression often contribute to sleep problems and intense or upsetting dreams too.

"The confounding factor is that if you are on an antidepressant, perhaps it's the depression itself and the weight of stress on the brain that causes increased nightmares," Silvert adds.

How to minimise unwanted side effects

It's important to speak to your doctor about any side effects you're having. Don't be tempted to stop taking an antidepressant or to reduce your dose on your own, as this may cause further side effects or withdrawal-like symptoms.

Take the medication at a different time

"For most SSRIs, it's recommended that you take them in the morning as they can be quite activating," Pennybacker says. "Although it's not specific to dreams, taking them later on in the day can interfere with sleep more generally.

"If you're experiencing unwanted side effects like nightmares and disturbances to your sleep, it'd be worth reducing your dosage and seeing if that helps, in consultation with whoever prescribed them."

Change your medication

Antidepressants help lots of people struggling with mental health problems, often in combination with other therapies too. For many people, any side effects improve within weeks of starting an antidepressant. In some cases, however, they may continue. If the side effects are outweighing the benefits, speak with your doctor about changing on to a different medication.

"People find they have different side effects on different SSRIs so you might want to try switching to a different type of SSRI," Pennybacker says. "Alternatively, there are other types of antidepressants like SNRIs which you might find that you experience fewer side effects on.”

Improve your bedtime routine

Making small changes to your evening routine may also help improve the quality of your sleep in general. "There are lots of things that can help manage sleep problems, from simply making your bedroom nice and cosy, to creating an evening routine," Buckley says.

"Choose a set time to go to bed and wake up or try only going to bed when you are tired. The hours leading up to sleep are also important so do an activity you find relaxing, such as a bath or breathing exercises, and switch off your devices a couple of hours before you sleep as blue light can keep you up.

“For help with the thoughts and feelings keeping you up at night speak with your GP or call Mind's Infoline on 0300 123 3393 for information and advice on where to get help," says Buckley. "The Samaritans are around for a chat any time of day or night on 116 123."

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