The DOI matches its Crossref record; 224 of the 230 references it cites were found in a registry or an index.
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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“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“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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Effects of Mood Stabilizers on Sleep and Circadian Rhythms: A Systematic Review
Caruso, V., Geoffroy, P. A., Alfì, G., Miniati, M., Riemann, D. W., Gemignani, A., & Palagini, L. (2024) · Current Sleep Medicine Reports · doi:10.1007/s40675-024-00298-5 · Cited by 2
“This is very interesting because dysregulation in REM sleep has been hypothesized in mood disorders [11], and lithium may regulate this part of sleep involved in emotion regulation.”
Self-citationMental health: The REM sleep paradox in depression
Hasegawa, E., & Lazarus, M. (2024) · Current Biology · doi:10.1016/j.cub.2024.06.053 · Cited by 2
Lechinger, J., Hollandt, J. H., Albuschat, K., Geremek, N., Weinhold, S. L., Drews, H. J., Nilsson, A. K., Deutschmann, C. M., & Göder, R. (2024) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-024-00485-0 · Cited by 2
Jain, A., Suryavanshi, J., Waindeskar, V., Gupta, M., Kaushal, A., & Kumar, H. (2024) · Palliative Care and Social Practice · doi:10.1177/26323524241283067 · Cited by 2
Nelson, B. W., Saeb, S., Barman, P., Verma, N., Allen, H., de Zambotti, M., Baker, F. C., Arra, N., Sridhar, N., Sullivan, S. S., et al. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70036 · Cited by 2
“…was the 4-stage sleep classification algorithm, given the clinical relevance of the multi-stage classification in the study of sleep health in conditions such as depression and Parkinson's disease (Postuma et al. 2009, 2006; MacDonald and Cote 2021; Sixel-Döring et al. 2011; Palagini et al. 2013).”
Cdkl5 Knockout Mice Recapitulate Sleep Phenotypes of CDKL5 Deficient Disorder
Cao, L., Zhang, X., Lou, T., Ma, J., Wang, Z., Kim, S. J., Vogt, K. E., Hirano, A., Tanaka, T., Kikkawa, Y., et al. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26083754 · Cited by 3
“Chronic sleep deprivation could lead to depression [48,49], and increased REMS amount has been considered as a biological marker of depression [50].”
Chen, Y., Ye, J., Chen, J., Zhen, Z., Tang, C., Ren, S., Han, Q., & Gao, D. (2025) · Nature and Science of Sleep · doi:10.2147/nss.s518104 · Cited by 2
“30 In addition, nighttime sleep interruption and sleep instability in NT1 patients are the main characteristics of their insomnia and are also one of the key factors leading to emotional disorders.”
Le, F., Yap, Y., Dumuid, D., & Wiley, J. F. (2025) · Annals of Behavioral Medicine · doi:10.1093/abm/kaaf050 · Cited by 3
“Although REM is important for negative affect experience 17–20 and emotional processing more broadly, 3,19–22 longer REM (in combination with shorter REM latency resulting in increased REM pressure) has been observed in individuals with affective disorders.”
Nightly dynamics of emotional content in dreams
Palmieri, J., Elce, V., & Schönauer, M. (2025) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2025.109248 · Cited by 3
Moretto, U., & Palagini, L. (2019) · Handbook of behavioral neuroscience · doi:10.1016/b978-0-12-813743-7.00046-3 · Cited by 2
Self-citationDopamine in REM Sleep Regulation
Khanday, M. A., Yadav, R. K., & Mallick, B. N. (2016) · Springer eBooks · doi:10.1007/978-3-319-46437-4_1 · Cited by 2
Depressive symptoms and sleep disturbances in Korean American women
Kim, E., Kim, S., & Cain, K. C. (2017) · Asian/Pacific Island Nursing Journal · doi:10.9741/23736658.1041 · Cited by 1
Cairns, A., & Bogan, R. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2016.11.023 · Cited by 2
Riveros, M. E., & Retamal, M. A. (2018) · Frontiers in Physiology · doi:10.3389/fphys.2018.00693 · Cited by 2
“These characteristics are similar to characteristics of sleep in depression (Palagini et al., 2013).”
BackgroundKomoltsev, I. G., Levshina, I. P., Novikova, M. R., Тишкина, А. О., Stepanichev, M. Y., & Gulyaeva, N. V. (2018) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-018-0631-3 · Cited by 2
“Changes in sleep in depression are largely opposite to those seen in patients after CCT. Data from several studies indicate that sleep impairments may be predictors of the appearance of clinical symptoms and the effectiveness of pharmacological treatments in depression [Palagini et al., 2013].”
BackgroundResultFerini‐Strambi, L., & Marelli, S. (2014) · Springer eBooks · doi:10.1007/978-88-470-5388-5_25 · Cited by 2
RetractedSchlaf, Lernen und Gedächtnis: Relevanz für Psychiatrie und Psychotherapie
Göder, R., Nissen, C., & Rasch, B. (2014) · Der Nervenarzt · doi:10.1007/s00115-013-3894-5 · Cited by 2
Hagemann, N., Kirtley, O. J., Lafit, G., Wampers, M., Achterhof, R., Hermans, K. S. F. M., Hiekkaranta, A. P., Lecei, A., Vancampfort, D., & Myin‐Germeys, I. (2021) · doi:10.31234/osf.io/yx2eb · Cited by 2
Chronotherapie affektiver Störungen: Grundlagen und klinische Aspekte
Ludwig, V. M., Münch, I., Wirz‐Justice, A., & Ritter, P. S. (2022) · Der Nervenarzt · doi:10.1007/s00115-022-01323-0 · Cited by 1
“Für depressive Episoden konnte eine Veränderung der Schlafstruktur im EEG objektiviert werden [24].”
BackgroundThiesse, L., Staner, L., Bourgin, P., Comtet, H., Fuchs, G., Kirscher, D., Roth, T. G., Schaffhauser, J.-Y., Saoud, J. B., & Viola, A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0291593 · Cited by 1
Huang, J., McPhillips, M., Li, M., Spira, A. P., Calderon, R., & Li, J. (2024) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/08919887241304769 · Cited by 1
“10,22 However, fi ndings in community samples are highly varied.”
Jiang, H., Weihs, A., Frenzel, S., Klinger-König, J., Ewert, R., Stubbe, B., Berger, K., Penzel, T., Fietze, I., Bülow, R., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.005 · Cited by 3
Using Wearable Technology to Evaluate Sleep and Stress for Physicians
Harrell, M. L., Dayal, D., Rahaman, C. A., Dekle, J., Lister, R., Skelton, A., Brabston, E. W., Evely, T. B., Casp, A., & Momaya, A. M. (2025) · Southern Medical Journal · doi:10.14423/smj.0000000000001816 · Cited by 3
Sleep Paralysis: Pathogenesis, Clinical Manifestations, and Treatment Strategies
Wang, Y., Li, Q., Zhong, Z., Ouyang, Q., Zou, X., Yue, K., & Yao, D. (2025) · Journal of Integrative Neuroscience · doi:10.31083/jin38979 · Cited by 1
“However, while most patients experience improved sleep with SSRIs, a recent case report found that sertraline (a type of SSRIs) may cause isolated sleep paralysis as a potential side effect [ 173,174].”
Assessing REM Sleep as a Biomarker for Depression Using Consumer Wearables
Stretea, R., Milhem, Z., Fîntînari, V., Crișan, C. A., Stan, A., Petreuș, D., & Micluția, I. (2025) · Diagnostics · doi:10.3390/diagnostics15192498 · Cited by 1
“The sleep characteristics of many participants, otherwise formally undiagnosed, elicited the classical pattern of REM sleep disinhibition, supporting the idea that REM changes may prove useful in early screening or risk monitoring contexts [17].”
Gumbis, G., Puteikis, K., & Mameniškienė, R. (2025) · Medicina · doi:10.3390/medicina61101844 · Cited by 3
“…and the use of antidepressants—a drug class suggested for the treatment of the same disorder [20]—and suggests the need to consider the possible REM-inhibiting effects of antidepressants [21–23] that may potentially translate into states within the wake–REM transition, including episodes of SP [5].”
Niu, X., Sanders, K. E. G., Denis, D., Cunningham, T. J., Zhang, G., Kensinger, E. A., & Payne, J. D. (2025) · Behavioural Brain Research · doi:10.1016/j.bbr.2025.115932 · Cited by 1
Vigilance state dissociation induced by 5-MeO-DMT in mice
Bréant, B. J. B., Prius-Mengual, J., Andrews, A., Hoerder‐Suabedissen, A., Patel, J., Bannerman, D. M., Sharp, T., & Vyazovskiy, V. V. (2026) · Communications Biology · doi:10.1038/s42003-025-09412-x · Cited by 7
“Themotivationforthisstudywastoaddressthebidirectionalrelationship betweenpsychedelicsandsleep,sincesleepisknowntobeessentialforbrain development,neuralplasticity,andmentalhealth 16,32,33 .”
Tomacsek, V., Báthori, N., Bankó, É. M., Kelemen, R., Zoltán, V., & Simor, P. (2026) · Current Psychology · doi:10.1007/s12144-026-09088-4 · Cited by 1
“The observed link between hyperarousal and morning emotions is in line with the clinical observa - tion indicating more negative emotional states in depressed patients in the morning presumably linked to impaired emo - tion regulation during sleep (Palagini et al., 2013; Peeters et al., 2006).”
Vlahoyiannis, A., Bargiotas, P., Sakkas, G. K., Hadjigeorgiou, G., Bogdanis, G. C., & Giannaki, C. D. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00356-0 · Cited by 1
Touchette, É., Zaine, Y.-L. N., Garon‐Bissonnette, J., Lemieux, R., & Berthelot, N. (2026) · Sleep Medicine · doi:10.1016/j.sleep.2026.108951 · Cited by 1
Baghdad, W., Brouzi, M. Y. E., Ibouzine‐Dine, L., Abouyaala, O., Arbaoui, M. E., Kessam, F. Z., Dimaoui, A., Mallouk, H., Lamtai, M., Satté, A., et al. (2026) · Neurochemical Research · doi:10.1007/s11064-026-04788-6 · Cited by 2
Sleep, Sadness, and Depression
Manber, R., & Fairholme, C. P. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-417188-6.00011-6 · Cited by 1
Two types of REM sleep: The atonic and brain REM sleep
Cai, Z.-J. (2016) · Sleep and Hypnosis · doi:10.5350/sleep.hypn.2016.18.0113 · Cited by 1
“…Dongwu Road, Suzhou City, Jiangsu Province, 215128, PR China Telephone: +86 512 65299403 Sleep and Hypnosis Submit your manuscript at www.sleepandhypnosis.org 1979), suggesting the REM sleep tend to disrupt the emotional balance toward depression(Goldstein & Walker, 2014; Palagini et al., 2013).”
BackgroundResultInfluentialRapid eye movement sleep in adolescent females with borderline personality disorder
Nasreldin, M., Basheer, M. A., Khalil, M. A. E. F., Madbouly, N. M., Saleh, A. A., & Abdalraheem, E. A. A. (2022) · International Journal of Health Sciences · doi:10.53730/ijhs.v6ns7.11488 · Cited by 1
“Others interpret REM sleep changes as mere consequences of the neurobiological processes underlying these disorders or simply a sign of inefficient REM sleep processing of affectively toned stimuli (Palagini et al., 2013; Hafizi, 2013).”
Background
Metadata
- 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 (medical) › 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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