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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In the citing paper
“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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Cited by
Sorted by citations
Items 501–506 of 506
Sleep, Circadian Rhythms, and Major Depressive Disorder
Pedramfard, P. (2026) · IGI Global eBooks · doi:10.4018/979-8-2600-4270-0.ch008
Tanaka, Y., Otsuka, Y., Nakajima, S., Miyoshi, T., & Kaneita, Y. (2026) · Sleep Epidemiology · doi:10.1016/j.sleepe.2026.100172
Lan, Z., Lin, W., Wang, M., Chen, X., 修梅红, & Pan, A. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1876676
“In MDD, polysomnography revealed disrupted sleep continuity and altered REM architecture, patterns that mirror those observed in primary insomnia (19, 20).”
Espinoza, S. B. G., Macías, S., Reyes, L. F. C., Santana-Moreira, G. J., Escobar, K. M., Rodrigues, A. L. S., & Siteneski, A. (2026) · Medical Sciences · doi:10.3390/medsci14060646
“Moreover, poor sleep quality has been linked to both the onset and persistence of depressive symptoms [51,52] as well as to greater symptom severity in young adults [53].”
Yang, C., Pan, B., Guo, X., Wang, L., Jiang, Y., Jiang, C., & Zhang, W. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122610
Rod, A. (2014) · NORA - Norwegian Open Research Archives
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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