REM sleep dysregulation in depression: state of the art
Abstract
Disturbances of sleep are typical for most depressed patients and belong to the core symptoms of the disorder. Since the 1960s polysomnographic sleep research has demonstrated that besides disturbances of sleep continuity, depression is associated with altered sleep architecture, i.e., a decrease in slow wave sleep (SWS) production and disturbed rapid eye movement (REM) sleep regulation. Shortened REM latency (i.e., the interval between sleep onset and the occurrence of the first REM period), increased REM sleep duration and increased REM density (i.e., the frequency of rapid eye movements per REM period) have been considered as biological markers of depression which might predict relapse and recurrence. High risk studies including healthy relatives of patients with depression demonstrate that REM sleep alterations may precede the clinical expression of depression and may thus be useful in identifying subjects at high risk for the illness. Several models have been developed to explain REM sleep abnormalities in depression, like the cholinergic-aminergic imbalance model or chronobiologically inspired theories, which are reviewed in this overview. Moreover, REM sleep alterations have been recently considered not only as biological "scars" but as true endophenotypes of depression. This review discusses the genetic, neurochemical and neurobiological factors that have been implicated to play a role in the complex relationships between REM sleep and depression. We hypothesize on the one hand that REM sleep dysregulation in depression may be linked to a genetic predisposition/vulnerability to develop the illness; on the other hand it is conceivable that REM sleep disinhibition in itself is a part of a maladaptive stress reaction with increased allostatic load. We also discuss whether the REM sleep changes in depression may contribute themselves to the development of central symptoms of depression such as cognitive distortions including negative self-esteem and the overnight consolidation of negatively toned emotional memories.
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The role of REM sleep in mood regulation is controversial since several studies found that this stage has a depressant effect.
“Actually, the role of REM sleep in the mood regulation is somehow controversial since several studies found that this stage has a depressant effect (Palagini et al., 2013).”
From The Functional Role of Dreaming in Emotional Processes (2019) · cites this paper as Palagini et al., 2013
Depressed subjects show increases in rapid eye movement (REM) sleep.
“Depressed subjects also show reductions in slow wave (stage 3/4) sleep, increases in rapid eye movement (REM) sleep, including a shorter latency to REM initiation, a protraction of the REM sleep period, and increases in REM density (Palagini et al., 2013; Riemann et al., 2001; Tsuno et al., 2005).”
From The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. (2018) · cites this paper as Palagini et al., 2013
Depressed subjects show a protraction of the REM sleep period.
“Depressed subjects also show reductions in slow wave (stage 3/4) sleep, increases in rapid eye movement (REM) sleep, including a shorter latency to REM initiation, a protraction of the REM sleep period, and increases in REM density (Palagini et al., 2013; Riemann et al., 2001; Tsuno et al., 2005).”
From The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. (2018) · cites this paper as Palagini et al., 2013
Depressed subjects show reductions in slow wave (stage 3/4) sleep.
“Depressed subjects also show reductions in slow wave (stage 3/4) sleep, increases in rapid eye movement (REM) sleep, including a shorter latency to REM initiation, a protraction of the REM sleep period, and increases in REM density (Palagini et al., 2013; Riemann et al., 2001; Tsuno et al., 2005).”
From The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. (2018) · cites this paper as Palagini et al., 2013
Depressed subjects show increases in REM density.
“Depressed subjects also show reductions in slow wave (stage 3/4) sleep, increases in rapid eye movement (REM) sleep, including a shorter latency to REM initiation, a protraction of the REM sleep period, and increases in REM density (Palagini et al., 2013; Riemann et al., 2001; Tsuno et al., 2005).”
From The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. (2018) · cites this paper as Palagini et al., 2013
Depressed subjects show a shorter latency to REM initiation.
“Depressed subjects also show reductions in slow wave (stage 3/4) sleep, increases in rapid eye movement (REM) sleep, including a shorter latency to REM initiation, a protraction of the REM sleep period, and increases in REM density (Palagini et al., 2013; Riemann et al., 2001; Tsuno et al., 2005).”
From The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. (2018) · cites this paper as Palagini et al., 2013
The suppression of REM sleep by inflammation is the opposite of changes observed in depressed patients.
“However, exogenously-induced inflammation using both endotoxin and IFN-α also led to a suppression of REM sleep (Mullington et al., 2000; Raison et al., 2010), which is the opposite of changes observed in depressed patients (Palagini et al., 2013; Riemann et al., 2001; Tsuno et al., 2005).”
From The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. (2018) · cites this paper as Palagini et al., 2013
Antidepressant medications remediate a sleep problem influenced by inflammation.
“and remediate one of the sleep problems influenced by inflammation (Palagini et al., 2013; Riemann et al., 2001)”
From The role of inflammation in core features of depression: Insights from paradigms using exogenously-induced inflammation. (2018) · cites this paper as Palagini et al., 2013
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“…entrance into REM sleep, (2) increased intensity of REM sleep (indexed in the number of rapid eye movements), and (3) longer duration of REM sleep periods (Armitage 2007, Buysse 2004, Franzen & Buysse 2008, Gottesmann & Gottesman 2007, Harvey et al 2003, Palagini et al 2013, Tsuno et al 2005).”
BackgroundSleep and mental disorders: a meta-analysis of polysomnographic research
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BackgroundSelf-citationRole of neuropeptides in anxiety, stress, and depression: From animals to humans
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“…REM phases similarly to all classic antidepressant medications (i.e., tricyclic antidepressants, monoamine-oxidase inhibitors, selective serotonin re-uptake inhibitors, serotonine norepinephrine re-uptake inhibitors; noradrenaline re-uptake inhibitors) (for review see: Palagini et al., 2013). dels.”
Clarifying the role of sleep in depression: A narrative review
Pandi-Perumal, S. R., Monti, J. M., Burman, D., Ramanujam, K., BaHammam, A. S., Spence, D. W., Brown, G. M., & Narashimhan, M. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113239 · Cited by 335 · see citing works
Behavioral methods to study anxiety in rodents
Lezak, K. R., Missig, G., & Carlezon Jr, W. A. (2017) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2017.19.2/wcarlezon · Cited by 290 · see citing works
Tomaso, C. C., Johnson, A. B., & Nelson, T. D. (2021) · SLEEP · doi:10.1093/sleep/zsaa289 · Cited by 282 · see citing works
The future of rodent models in depression research
Gururajan, A., Reif, A., Cryan, J. F., & Slattery, D. A. (2019) · Nature Reviews Neuroscience · doi:10.1038/s41583-019-0221-6 · Cited by 269 · see citing works
Bao, Y.-P., Han, Y., Ma, J., Wang, R.-J., Shi, L., Wang, T.-Y., He, J., Yue, J.-L., Shi, J., Tang, X.-D., et al. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.01.032 · Cited by 275 · see citing works
Sleep deprivation, oxidative stress and inflammation
Atrooz, F., & Salim, S. (2019) · Advances in protein chemistry and structural biology · doi:10.1016/bs.apcsb.2019.03.001 · Cited by 259 · see citing works
Associations between sex hormones, sleep problems and depression: A systematic review
Morssinkhof, M. W. L., van Wylick, D. W., Priester-Vink, S., van der Werf, Y. D., den Heijer, M., van den Heuvel, O. A., & Broekman, B. F. P. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.08.006 · Cited by 210 · see citing works
Sleep in the anxiety-related disorders: A meta-analysis of subjective and objective research
Cox, R. C., & Olatunji, B. O. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101282 · Cited by 235 · see citing works
The microstructure of REM sleep: Why phasic and tonic?
Simor, P., van der Wijk, G., Nobili, L., & Peigneux, P. (2020) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101305 · Cited by 207 · see citing works
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Depression as a systemic syndrome: mapping the feedback loops of major depressive disorder
Wittenborn, A. K., Rahmandad, H., Rick, J., & Hosseinichimeh, N. (2016) · Psychological Medicine · doi:10.1017/s0033291715002044 · Cited by 207 · see citing works
“In fact, several excellent review articles provide more in-depth reviews of specific mechanisms (Mössner et al. 2007; De Raedt & Koster, 2010; Palagini et al. 2013).”
BackgroundBidirectional relationship between sleep and depression
Yasugaki, S., Okamura, H., Kaneko, A., & Hayashi, Y. (2023) · Neuroscience Research · doi:10.1016/j.neures.2023.04.006 · Cited by 216 · see citing works
The Functional Role of Dreaming in Emotional Processes
Scarpelli, S., Bartolacci, C., D'Atri, A., Gorgoni, M., & De Gennaro, L. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00459 · Cited by 190 · see citing works
“Actually, the role of REM sleep in the mood regulation is somehow controversial since several studies found that this stage has a depressant effect (Palagini et al., 2013).”
BackgroundCholinergic regulation of mood: from basic and clinical studies to emerging therapeutics
Dulawa, S. C., & Janowsky, D. S. (2019) · Molecular Psychiatry · doi:10.1038/s41380-018-0219-x · Cited by 187 · see citing works
“These changes include increases in rapid eye movement (REM) sleep duration, increases in REM density, reductions in REM latency, decreases in slow wave sleep, and disturbances in sleep continuity 52, 53, 54, 55 .”
BackgroundDooley, L. N., Kuhlman, K. R., Robles, T. F., Eisenberger, N. I., Craske, M. G., & Bower, J. E. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.09.006 · Cited by 176 · see citing works
“Indeed, antidepressant medications have anti-inflammatory effects on the body (Kenis and Maes, 2002), and remediate one of the sleep problems influenced by inflammation (Palagini et al., 2013; Riemann et al., 2001) while behavioral interventions that reduce somatic symptoms like fatigue also appear to work by reducing…”
Sleep correlates of depression and anxiety in an elderly A sian population
Yu, J., Rawtaer, I., Fam, J., Jiang, M., Feng, L., Kua, E. H., & Mahendran, R. (2015) · Psychogeriatrics · doi:10.1111/psyg.12138 · Cited by 178 · see citing works
The Neurobiological Mechanisms and Treatments of REM Sleep Disturbances in Depression
Wang, Y., Li, R., Zhang, M., Zhang, Z., Qu, W., & Huang, Z. (2015) · Current Neuropharmacology · doi:10.2174/1570159x13666150310002540 · Cited by 157 · see citing works
“Sleep EEG recordings in depression are often characterized by the following [3, 8, 10-13]: decreased sleep efficiency, for example, the time before falling asleep is prolonged and more awakening episodes after falling asleep [14-16]; reduced NREM sleep, disturbed distribution of delta activity, sleep cycle, and a redu…”
BackgroundZhang, M.-M., Ma, Y., Du, L.-T., Wang, K., Li, Z., Zhu, W.-L., Sun, Y.-H., Lu, L., Bao, Y., & Li, S.-X. (2022) · Neuroscience and Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104532 · Cited by 135 · see citing works
The bidirectional relation between emotional reactivity and sleep: From disruption to recovery.
Altena, E., Micoulaud-Franchi, J., Geoffroy, P., Sanz-Arigita, E. J., Bioulac, S., & Philip, P. (2016) · Behavioral Neuroscience · doi:10.1037/bne0000128 · Cited by 132 · see citing works
Sleep Disturbances in Mood Disorders
Rumble, M. E., White, K. H., & Benca, R. M. (2015) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2015.07.006 · Cited by 143 · see citing works
Internalised HIV-stigma, loneliness, depressive symptoms and sleep quality in people living with HIV
Fekete, E. M., Williams, S. L., & Skinta, M. D. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1357816 · Cited by 128 · see citing works
“Individuals who are depressed tend to have more sleep disturbances, which are likely caused by more frequent REM periods during sleep (Palagini et al., 2013).”
BackgroundThe Effects of Sleep Continuity Disruption on Positive Mood and Sleep Architecture in Healthy Adults
Finan, P. H., Quartana, P. J., & Smith, M. T. (2015) · Sleep · doi:10.5665/sleep.5154 · Cited by 140 · see citing works
Psychiatric Disorders and Sleep Issues
Sutton, E. L. (2014) · Medical Clinics of North America · doi:10.1016/j.mcna.2014.06.009 · Cited by 119 · see citing works
“Regulation of rapid eye movement (REM) sleep may be particularly germane to the development and treatment of depression, although the role of the observed effect of REM suppression by many antidepressants is unclear.(92)”
BackgroundSleep as a biomarker for depression
Wichniak, A., Wierzbicka, A., & Jernajczyk, W. (2013) · International Review of Psychiatry · doi:10.3109/09540261.2013.812067 · Cited by 117 · see citing works
“Changes of polysomnographic sleep patterns of depressed patients can be divided into three types (Benca et al., ISSN 0954–0261 print/ISSN 1369–1627 online © 2013 Institute of Psychiatry DOI: 10.3109/09540261.2013.812067 1992; Palagini et al., 2013; Steiger & Kimura, 2010; Wichniak et al., 2012).”
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“Previous literature has shown that shortened REM latency can be considered as a biological mark of depression relapse [9].”
InfluentialKang, S., & Cho, S. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21062148 · Cited by 112 · see citing works
“These polysomnography findings have been considered neurophysiological markers of MDD that might estimate future recurrence or relapse [9].”
BackgroundA literature review of heart rate variability in depressive and bipolar disorders
Bassett, D. L. (2015) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867415622689 · Cited by 110 · see citing works
“In addition, the percentage of REM sleep was consistently increased, as would be expected from previous research (Palagini et al., 2013; Paykel et al., 1995; Steiger and Kimura, 2010).”
BackgroundResultWells, A. M., Ridener, E., Bourbonais, C. A., Kim, W., Pantazopoulos, H., Carroll, F. I., Kim, K., Cohen, B. M., & Carlezon, W. A. (2017) · Journal of Neuroscience · doi:10.1523/jneurosci.0885-17.2017 · Cited by 108 · see citing works
“Humans with MDD also have lower latencies to the first REM bout, suggesting more rapid cycling through sleep stages (Palagini et al., 2013).”
BackgroundSleep Inconsistency and Markers of Inflammation
Dzierzewski, J. M., Donovan, E. K., Kay, D. B., Sannes, T. S., & Bradbrook, K. E. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.01042 · Cited by 106 · see citing works
Finan, P. H., Richards, J. M., Gamaldo, C. E., Han, D., Leoutsakos, J. M., Salas, R., Irwin, M. R., & Smith, M. T. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6262 · Cited by 90 · see citing works
Regulation of neuron-astrocyte metabolic coupling across the sleep-wake cycle
Petit, J.-M., & Magistretti, P. J. (2016) · Neuroscience · doi:10.1016/j.neuroscience.2015.12.007 · Cited by 92 · see citing works
“, 2013) as well as the impairment of PS in mood disorders (Palagini et al., 2013).”
BackgroundTseng, Y.-T., Zhao, B., Chen, S., Ye, J., Liu, J., Liang, L., Ding, H., Schaefke, B., Yang, Q., Wang, L., et al. (2022) · Neuron · doi:10.1016/j.neuron.2021.12.033 · Cited by 92 · see citing works
Biological rhythms and chronotherapeutics in depression
Geoffroy, P. A., & Palagini, L. (2021) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.110158 · Cited by 127 · see citing works
Self-citationA noradrenergic-hypothalamic neural substrate for stress-induced sleep disturbances
Antila, H., Kwak, I., Choi, A., Pisciotti, A., Covarrubias, I., Baik, J., Eisch, A. J., Beier, K. T., THOMAS, S. A., Weber, F., et al. (2022) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2123528119 · Cited by 91 · see citing works
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“Furthermore, REMS is suppressed by most antidepressants (51) and some antidepressants interfere with the homeostatic control of REMS (52).”
BackgroundTop-down control of arousal and sleep: Fundamentals and clinical implications
Krone, L. B., Frase, L., Piosczyk, H., Selhausen, P., Zittel, S., Jahn, F., Kühn, M., Feige, B., Mainberger, F., Klöppel, S., et al. (2016) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.12.005 · Cited by 89 · see citing works
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Self-citationExercise improves the quality of slow-wave sleep by increasing slow-wave stability
Park, I., Díaz, J., Matsumoto, S., Iwayama, K., Nabekura, Y., Ogata, H., Kayaba, M., Aoyagi, A., Yajima, K., Satoh, M., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-83817-6 · Cited by 85 · see citing works
Prefrontal cortical regulation of REM sleep
Hong, J., Lozano, D. E., Beier, K. T., Chung, S., & Weber, F. (2023) · Nature Neuroscience · doi:10.1038/s41593-023-01398-1 · Cited by 83 · see citing works
“Thus, our finding that mPFC activation promotes REM sleep and phasic events may mechanistically explain the shortened latency to REM sleep, its increased duration and the increased EM density characteristic of sleep in depression 12 .”
BackgroundConsolidative mechanisms of emotional processing in REM sleep and PTSD
Murkar, A., & Koninck, J. D. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.03.001 · Cited by 82 · see citing works
Feld, G. B., & Jan Born, A. (2019) · Neuropsychopharmacology · doi:10.1038/s41386-019-0490-9 · Cited by 79 · see citing works
Relationship of physical activity and sleep with depression in college students
Cahuas, A., He, Z., Zhang, Z., & Chen, W. (2019) · Journal of American College Health · doi:10.1080/07448481.2019.1583653 · Cited by 81 · see citing works
“Depression also impacts sleep patterns and can lead to higher rates of sleep disturbance and irregular rapid eye movement (REM) sleep.(21) A recent meta-analysis suggests that both sleep deprivation and too much sleep are associated with depression in adults.”
BackgroundBoehm, M. A., Lei, Q. M., Lloyd, R. M., & Prichard, J. R. (2016) · Journal of American College Health · doi:10.1080/07448481.2016.1205073 · Cited by 80 · see citing works
“Among individuals with depression, sleep disturbances often include difficulty with sleep initiation, frequent early awakenings, and insomnia or hypersomnia.(10) Depression is also associated with electrophysiological disturbances in sleep, including disinhibition of rapid eye movement (REM) sleep, REM sleep fragmenta…”
BackgroundInterpersonal distress is associated with sleep and arousal in insomnia and good sleepers
Gunn, H. E., Troxel, W., Hall, M. H., & Buysse, D. J. (2013) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2013.11.010 · Cited by 77 · see citing works
“Both REM and insomnia have been linked to difficulties with emotion processing [43,44].”
BackgroundChen, X., Luo, J., Leng, Y., Yang, Y., Zweifel, L. S., Palmiter, R. D., & Storm, D. R. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2015.12.012 · Cited by 74 · see citing works
“Depressed patients exhibit a number of disturbances including cognitive defects [37], smaller brain size [38, 39], altered sleep pattern [26], and deficits in spatial navigation [31].”
BackgroundThe sleep benefit in episodic memory: An integrative review and a meta-analysis.
Berres, S., & Erdfelder, E. (2021) · Psychological Bulletin · doi:10.1037/bul0000350 · Cited by 74 · see citing works
The sleep phenotype of Borderline Personality Disorder: A systematic review and meta-analysis
Winsper, C., Tang, N. K. Y., Marwaha, S., Lereya, S. T., Gibbs, M., Thompson, A. D., & Singh, S. P. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.12.008 · Cited by 74 · see citing works
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Melanin-Concentrating Hormone (MCH): Role in REM Sleep and Depression
Torterolo, P., Scorza, C., Lagos, P., Urbanavicius, J., Benedetto, L., Pascovich, C., López‐Hill, X., Chase, M. H., & Monti, J. M. (2015) · Frontiers in Neuroscience · doi:10.3389/fnins.2015.00475 · Cited by 71 · see citing works
Pesonen, A., Gradisar, M., Kuula, L., Short, M. A., Merikanto, I., Tark, R., Räikkönen, K., & Lahti, J. M. T. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.11.077 · Cited by 69 · see citing works
Wainberg, M., Jones, S. E., Beaupre, L. M., Hill, S. L., Felsky, D., Rivas, M. A., Lim, A. S. P., Ollila, H. M., & Tripathy, S. J. (2021) · PLOS Medicine · doi:10.1371/journal.pmed.1003782 · Cited by 64 · see citing works
Circadian insights into the biology of depression: Symptoms, treatments and animal models
Mendoza, J. (2019) · Behavioural Brain Research · doi:10.1016/j.bbr.2019.112186 · Cited by 64 · see citing works
Sleep Quality, Depression, and Cognitive Function in Non-Demented Older Adults
Guan, Q., Hu, X., Ma, N., He, H., Duan, F., Li, X., Luo, Y., & Zhang, H. (2020) · Journal of Alzheimer s Disease · doi:10.3233/jad-190990 · Cited by 63 · see citing works
“Although depression could disrupt sleep architecture to affect memory recall [71], this mediation effect might account for a relatively small extent of the total depression-memory relationship.”
Križan, Z., & Hisler, G. C. (2019) · European Journal of Personality · doi:10.1002/per.2191 · Cited by 63 · see citing works
Gourgouvelis, J., Yielder, P. C., Clarke, S. T., Behbahani, H., & Murphy, B. A. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00037 · Cited by 63 · see citing works
Ding, H., Cui, X., Cui, S., Ye, H., Hu, X., Zhao, H., Liu, Y., & Zhang, Y. (2018) · Neuroscience Letters · doi:10.1016/j.neulet.2018.09.059 · Cited by 60 · see citing works
Hrozanova, M., Klöckner, C. A., Sandbakk, Ø. B., Pallesen, S., & Moen, F. (2021) · PLoS ONE · doi:10.1371/journal.pone.0253376 · Cited by 60 · see citing works
“depression [46], excessive sleepiness [47]), which is not representative of the current population of junior athletes.”
BackgroundHuang, Y., & Zhu, M. (2020) · Nature and Science of Sleep · doi:10.2147/nss.s256625 · Cited by 64 · see citing works
Seol, J., Lee, J., Park, I., Tokuyama, K., Fukusumi, S., Kokubo, T., Yanagisawa, M., & Okura, T. (2022) · Scientific Reports · doi:10.1038/s41598-022-19841-x · Cited by 59 · see citing works
Volitional limbic neuromodulation exerts a beneficial clinical effect on Fibromyalgia
Goldway, N., Ablin, J. N., Lubin, O., Zamir, Y., Keynan, J. N., Or‐Borichev, A., Cavazza, M., Charles, F., Intrator, N., Brill, S., et al. (2018) · NeuroImage · doi:10.1016/j.neuroimage.2018.11.001 · Cited by 57 · see citing works
“Of the numerous manifestations of aberrant sleep in Fi-bromyalgia, our focus was on REM latency, which is known to be related to amygdala activation (Luppi et al., 2004; Nofzinger et al., 2004) and affective dysregulation in mood disorders (Kupfer, 1976; Palagini et al., 2013).”
Developmental changes in sleep and their relationships to psychiatric illnesses
Tesler, N., Gerstenberg, M., & Huber, R. (2013) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e328365a335 · Cited by 57 · see citing works
Sleep Disturbances and Depression in the Multi-Ethnic Study of Atherosclerosis
Alcántara, C., Biggs, M. L., Davidson, K. W., Delaney, J. A., Jackson, C. L., Zee, P. C., Shea, S. J. C., & Redline, S. S. (2016) · SLEEP · doi:10.5665/sleep.5654 · Cited by 55 · see citing works
Hopkins, J. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00922 · Cited by 53 · see citing works
“Cartwright (2010, Ch. 4; see also Nutt et al., 2008; Palagini et al., 2013) describes how severe depression often involves a premature transition from early light sleep to a disordered form of REM.”
BackgroundKo, C., Fan, J., Hu, A., Su, H., Yang, J., Huang, L., Yan, F., Zhang, H., & Zeng, Y. (2019) · Brain and Behavior · doi:10.1002/brb3.1287 · Cited by 52 · see citing works
“Additionally, the gut microbiota alterations manifested in IH and SF mimic in OSAHS animal models (Moreno‐Indias et al., 2015; Poroyko et al., 2016).”
BackgroundResultInfluentialHoyos, C. M., Gordon, C. J., Terpening, Z., Norrie, L. M., Lewis, S. J. G., Hickie, I. B., & Naismith, S. L. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02606-z · Cited by 52 · see citing works
Sleep in adolescent depression: physiological perspectives
Urrila, A. S., Paunio, T., Palomäki, E., & MARTTUNEN, M. J. (2015) · Acta Physiologica · doi:10.1111/apha.12449 · Cited by 52 · see citing works
“The exact mechanisms by which increased amount and intensity of REM sleep and depression are linked are not fully understood, but various theories and models have been proposed (for a recent thorough review see Palagini et al. 2013).”
BackgroundInfluentialShariq, A. S., Rosenblat, J. D., Alageel, A. A. S., Mansur, R. B., Rong, C., Ho, R., Ragguett, R., Pan, Z., Brietzke, E. M., & McIntyre, R. S. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.12.008 · Cited by 50 · see citing works
Richards, A., Metzler, T. J., Ruoff, L. M., Inslicht, S. S., Rao, M., Talbot, L. S., & Neylan, T. C. (2013) · Journal of Sleep Research · doi:10.1111/jsr.12064 · Cited by 49 · see citing works
“It is also possible that the REM interaction effect is highly sensitive to loss of severe PTSD cases, as may have been the case in this sample, and our previous research indicates strongly that comorbid MDD is more common as CAPS scores increase.”
BackgroundInfluentialPolysomnography in seasonal affective disorder: A systematic review and meta-analysis
Bertrand, L., d’Ortho, M., Reynaud, È., Lejoyeux, M., Bourgin, P., & Geoffroy, P. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.05.080 · Cited by 50 · see citing works
Feng, H., Qiao, Q., Luo, Q.-F., Zhou, J., Lei, F., Chen, Y., Wen, S., Chen, W.-H., Pang, Y.-J., Hu, Z., et al. (2024) · Research · doi:10.34133/research.0355 · Cited by 49 · see citing works
“On the other hand, previous studies have tried to use the latency as a REM sleep parameter to predict depression occurrence and have found that this parameter is not reliable [66–68].”
Multi-Level Processes and Retina–Brain Pathways of Photic Regulation of Mood
Maruani, J., & Geoffroy, P. A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11020448 · Cited by 50 · see citing works
“It is thus hypothesized that this misalignment between circadian rhythms and the light–dark cycle would lead to depressive symptoms and so would explain both the early awakening and the shortening of the rapid eye movement (REM) sleep latency, two circadian markers frequently found altered in depressive disorders [71].”
BackgroundNaganuma, F., Bandaru, S. S., Absi, G., Mahoney, C. E., Scammell, T. E., & Vetrivelan, R. (2018) · Neurobiology of Disease · doi:10.1016/j.nbd.2018.08.012 · Cited by 47 · see citing works
Poor sleep quality in systemic lupus erythematosus: does it depend on depressive symptoms?
Palagini, L., Tani, C., Bruno, R. M., Gemignani, A., Mauri, M. F., Bombardieri, S., Riemann, D. W., & Mosca, M. (2014) · Lupus · doi:10.1177/0961203314540762 · Cited by 47 · see citing works
Self-citationNightmares and nonsuicidal self-injury: The mediating role of emotional dysregulation
Ennis, C. R., Short, N. A., Moltisanti, A. J., Smith, C. E., Joiner, T. E., & Taylor, J. E. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.04.003 · Cited by 48 · see citing works
Selective activation of serotoninergic dorsal raphe neurons facilitates sleep through anxiolysis
Venner, A., Broadhurst, R. Y., Sohn, L. T., Todd, W. D., & Fuller, P. M. (2019) · SLEEP · doi:10.1093/sleep/zsz231 · Cited by 54 · see citing works
“To this end, SSRIs are a frequently employed and highly effective treatment for anxiety and depression in humans, but they also influence sleep, specifically REM sleep [52].”
BackgroundChai, Y., Gehrman, P., Yu, M., Mao, T., Deng, Y., Rao, J., Shi, H., Quan, P., Xu, J., Zhang, X., et al. (2023) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2214505120 · Cited by 44 · see citing works
Sleep quality in eating disorders: A systematic review and meta-analysis
Degasperi, G., Meneo, D., Curati, S., Cardi, V., Baglioni, C., & Cellini, N. (2024) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2024.101969 · Cited by 50 · see citing works
Self-citationHowe, L. D., Signal, T. L., Paine, S., Sweeney, B., Priston, M., Muller, D., Lee, K., Huthwaite, M., & Gander, P. H. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008910 · Cited by 44 · see citing works
Liu, Z.-Z., Tein, J.-Y., Jia, C.-X., & Liu, X. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2020.11.015 · Cited by 44 · see citing works
Krawczak, E. M., Minuzzi, L., Hidalgo, M. P. L., & Frey, B. N. (2016) · Archives of Women s Mental Health · doi:10.1007/s00737-016-0612-x · Cited by 43 · see citing works
“For example, individuals suffering from major depressive disorder (MDD) and bipolar disorder (BD) show significant sleep and circadian rhythm disturbances during mood episodes (Gonzalez 2014; Harvey 2011; McClung 2013; Palagini et al. 2013; WirzJustice 2006).”
BackgroundBogusch, L. M., Fekete, E. M., & Skinta, M. D. (2016) · Mindfulness · doi:10.1007/s12671-016-0535-7 · Cited by 44 · see citing works
“Moreover, increased REM density associated with depressive symptoms changes sleep structure and may interfere with sleep quality (Palagini et al. 2013).”
BackgroundInfluentialMcCullough, K. M., Missig, G., Robble, M. A., Foilb, A. R., Wells, A. M., Hartmann, J., Anderson, K. J., Neve, R. L., Nestler, E. J., Ressler, K. J., et al. (2021) · Biological Psychiatry · doi:10.1016/j.biopsych.2020.12.030 · Cited by 43 · see citing works
Melanin-concentrating hormone (MCH) modulates the activity of dorsal raphe neurons
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Segalàs, C., Labad, J., Salvat‐Pujol, N., Real, E., Alonso, P., Bertolín, S., Jiménez‐Múrcia, S., Soriano‐Mas, C., Monasterio, C., Menchón, J. M., et al. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03038-z · Cited by 42 · see citing works
The association between emotional dysregulation and REM sleep features in insomnia disorder.
Galbiati, A., Sforza, M., Fasiello, E., Casoni, F., Marrella, N., Leitner, C., Zucconi, M., & Ferini-Strambi, L. (2020) · Brain and Cognition · doi:10.1016/j.bandc.2020.105642 · Cited by 42 · see citing works
Sleep, Sleep Disorders, and Mental Health: A Narrative Review
Howarth, N. E., & Miller, M. A. (2024) · Heart and Mind · doi:10.4103/hm.hm-d-24-00030 · Cited by 46 · see citing works
“[14] Reduced SWS has also been associated with insomnia, [15] mood, and anxiety disorders, [16] generalized alterations of SWS are present in psychosis and neurodevelopmental conditions, [17] and anxiety.”
Lee, S.-A., Paek, J.-H., & Han, S.-H. (2016) · Sleep and Breathing · doi:10.1007/s11325-016-1323-2 · Cited by 40 · see citing works
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“It has been described that depression is associated with disrupted REM sleep—shortened REM latency increased REM duration, and increased REM density [140].”
BackgroundREM sleep homeostasis in the absence of REM sleep: Effects of antidepressants
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“…a, b, *, Keith Wafford a, Elaine Shanks a, Marcin Ligocki a, Dale M. Edgar a, Derk-Jan Dijk b a Lilly Research Laboratories, Windlesham, Surrey, GU20 6PH, UK b Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guilford,…”
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“The optimism-depressive mood-sleep quality link was conceptualized as optimists adopting active coping strategies, maintaining better health, and being more hopeful, resulting in depressive mood (Chang et al., 2013; Karlsson et al., 2011), and in turn better sleep quality (Palagini et al., 2013).”
BackgroundSex differences in sleep, anhedonia, and HPA axis activity in a rat model of chronic social defeat
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“HPA axis dysregulation and the accompanying hyperarousal impacts sleep architecture evidenced by impaired sleep continuity, reductions in NREMS, and disinhibition of REMS (Palagini et al., 2013; Pillai et al., 2011).”
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“It is known that depression is associated with disturbed sleep and alternation in REM-Sleep [8].”
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“This is 2 unsurprising, considering that sleep disturbances are reported by up to 90 % of MDD 3 patients (Baglioni et al., 2011; Palagini et al., 2013), however, these between-group 4 differences in sleep quality may have also influenced emotional memory processing 5 (Tempesta, De Gennaro, Natale,…”
- Authors
- Palagini, L., Baglioni, C., Ciapparelli, A., Gemignani, A., & Riemann, D.
- Affiliations
- University of Pisa (IT)
- University of Freiburg (DE)
- Corresponding author
- Palagini, Laura
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 17
- Issue
- 5
- Pages
- 377-390
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2022024201
- Cited by
- 513
- References
- 230
- Citations by year
- 2026: 53 · 2025: 59 · 2024: 42 · 2023: 61 · 2022: 35 · 2021: 45 · 2020: 31 · 2019: 38 · 2018: 35 · 2017: 24 · 2016: 31 · 2015: 30 · 2014: 18 · 2013: 10
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- REM sleep, depression, REM latency, REM density, REM sleep duration, sleep architecture, slow-wave sleep, depression biomarkers, endophenotypes, chronobiology, genetic susceptibility, allostatic load, maladaptive stress response, emotional memory consolidation, cognitive distortions, recurrence prediction
- MeSH terms
- Antidepressive Agents, Brain, Depression, Humans, Sleep Deprivation, Sleep Wake Disorders, Sleep, REM, Stress, Psychological
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