Sleep Disorders and Medication Side Effects in Depression

Medication Consultation

Hello Dr.
Tang: I am a patient with severe depression and have been on medication for over a year, specifically Seroxat and Stilnox.
Since November of last year, I have noticed that my sleep has been deteriorating, so I started taking an extra Stilnox on my own.
Later, I realized that even though I had gone to bed, I would get up shortly after to eat.
I would consume a lot of food, sometimes a large pot of porridge or a significant amount of cookies, and the next day I would have no recollection of what I had eaten.
It was only when my mother scolded me for getting up in the middle of the night to eat and not cleaning up afterward that I realized something was wrong.
I argued with her for a long time, but she said she had noticed me eating at night multiple times, appearing dazed, and she even suggested that I was possessed.
Recently, she has been urging me to seek a spiritual cleansing.
I would like to ask the doctor, has my condition worsened, or could this be a side effect of the medication?

momoko, 30~39 year old female. Ask Date: 2003/03/06

Dr. Tang Xinbei reply Psychiatry

Dear friend,
In your recent letter, you inquired about two medications: Seroxat and Stilnox.
Seroxat is a selective serotonin reuptake inhibitor (SSRI) antidepressant, which theoretically may have an appetite-suppressing effect (contrary to your situation).
Stilnox, also known as Zolpidem, is one of the latest sleep aids and is considered to have a higher safety profile with lower risks of addiction or dependence.
However, recent reports have indicated that long-term use may lead to instances of transient memory loss, and some individuals may experience confusion or memory issues even upon initial use, which seems somewhat similar to what you described.
I cannot draw conclusions about your situation based solely on the information provided.
I recommend discussing this further with your treating physician for a more thorough evaluation and necessary examinations.
Additionally, regarding the use of sleep aids, I suggest adopting a "use only when necessary" principle, considering their use only in the following circumstances:
1.
If you did not sleep well the previous night and have important matters to attend to the next day, you may consider using it tonight to avoid poor sleep affecting your performance.
2.
If you did not sleep well two nights ago and again last night, and you are concerned about potentially poor sleep affecting your work or studies today, you may consider using it tonight.
3.
If your usual routine is to sleep at 10 PM and wake up at 7 AM, but you need to wake up at 5 AM for an important matter tomorrow, you may consider using it tonight to prevent difficulties falling asleep due to an earlier bedtime.
Moreover, it is advisable to use the lowest effective dose (for example, one or half a tablet), and typically, weekends are less busy, so it is best to avoid using sleep aids on Friday or Saturday nights.
Wishing you peace and joy!

Reply Date: 2003/03/06

More Info

Understanding sleep disorders, especially in the context of depression and medication, is crucial for managing both mental health and overall well-being. In your case, you are experiencing significant sleep disturbances while being treated for severe depression with medications such as Seroxat (a selective serotonin reuptake inhibitor, or SSRI) and Stilnox (a sleep aid).
Firstly, it’s important to recognize that sleep disorders are common in individuals with depression. Insomnia, hypersomnia, and disrupted sleep patterns can exacerbate depressive symptoms, creating a vicious cycle. SSRIs like Seroxat can sometimes lead to sleep disturbances as a side effect, although they are generally intended to improve mood and anxiety. In some patients, SSRIs can cause insomnia or vivid dreams, which may contribute to feelings of fatigue and confusion during the day.

Stilnox, on the other hand, is a medication designed to help with sleep initiation and maintenance. However, it can also have side effects, particularly when taken in higher doses than prescribed. The phenomenon you described—waking up with no memory of eating during the night—could be indicative of a condition known as "sleep-related eating disorder," which can occur with the use of certain sleep medications. This condition is characterized by episodes of eating while in a state of sleep, often with little to no recollection of the event upon waking.
Your experience of waking up and finding that you have consumed large amounts of food without memory of doing so is concerning and suggests that the combination of your medications may not be working harmoniously. It’s also possible that increasing the dose of Stilnox on your own could have led to these side effects. The fact that you are experiencing these episodes frequently indicates that it may be time to reassess your treatment plan with your healthcare provider.

In terms of your mental health, the worsening of your sleep issues could indeed be a sign of your depression intensifying, or it could be a direct result of the medications you are taking. It’s essential to communicate openly with your doctor about these experiences. They may suggest adjusting your medication, switching to a different sleep aid, or incorporating behavioral strategies to improve your sleep hygiene.
Cognitive Behavioral Therapy for Insomnia (CBT-I) is one effective approach that can help address the underlying thoughts and behaviors contributing to your sleep issues. This therapy focuses on changing the way you think about sleep and developing better sleep habits.
Moreover, it’s crucial to avoid self-medicating or adjusting your medication without professional guidance. Doing so can lead to increased risks of side effects and complications. Your doctor may also want to evaluate other factors that could be contributing to your sleep disturbances, such as lifestyle habits, stressors, or other underlying health conditions.

In summary, your situation highlights the complex interplay between depression, medication, and sleep disorders. It’s vital to work closely with your healthcare provider to find a balanced approach that addresses both your mental health and sleep needs. Regular follow-ups and open communication about your symptoms will be key in managing your condition effectively.

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