Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression
Open accessAbstract
Background: Sleep effects of antidepressants are important clinically and for elucidating mechanism of action: selective serotonin reuptake inhibitors disturb sleep and 5-HT 2 receptor-blocking compounds may enhance sleep quality. Aims: To compare the objective and subjective effects on sleep of paroxetine and nefazodone in patients with moderate to severe depression. Method: Forty patients with depression were randomised to take paroxetine 20-40 mg/day or nefazodone 400–600 mg/day for 8 weeks. Objective and subjective quality of sleep and depression measures were assessed throughout. Results: Nefazodone significantly increased objective sleep efficiency and total sleep time, and improved subjective sleep on days 3 and 10. Paroxetine decreased sleep efficiency early in treatment and some sleep disruption remained at week 8. Paroxetine but not nefazodone produced marked suppression of rapid eye movement (REM) sleep. Conclusions: Nefazodone improves sleep in early treatment compared with paroxetine in patients with moderate to severe depression. These effects are seen within the first 2 weeks of treatment and diminish thereafter.
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Sleep time was less, and disruption greater, for paroxetine (20-40mg) compared to nefazodone (400-600mg).
“(Hicks et al., 2002) found that sleep time was less, and disruption greater, for paroxetine (20-40mg) compared to nefazodone (400-600mg).”
From Antidepressants and their effect on sleep (2005) · cites this paper as Hicks et al., 2002
The Method gives the stated doses, and the Results and Discussion report more sleep disruption and less total sleep time with paroxetine than with nefazodone early in treatment. The claim omits the timing qualification: the Discussion says the differences were much less marked at eight weeks, and the Clinical Implications report no difference in overall sleep quality by then. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNefazodone was associated with less nocturnal disturbance than paroxetine.
“Previous analyses indicated that nefazodone was associated with less nocturnal disturbance than fluoxetine (Rush et al., 1998) or paroxetine (Hicks et al., 2002).”
From Antidepressants and their effect on sleep (2005) · cites this paper as Hicks et al., 2002
The Discussion reports improved sleep maintenance early in treatment with nefazodone and increased sleep disturbance with paroxetine. The claim omits that timing: the Conclusions say the difference diminished thereafter, and the Clinical Implications report no difference in sleep quality by eight weeks. (LLM, conf=0.84)
Experimental — accuracy not yet measuredNefazodone presents some of the more positive sleep outcomes of any antidepressant, frequently showing better sleep time and less disruption than SSRIs.
“Nefazodone presents some of the more positive sleep outcomes of any antidepressant, frequently showing better sleep time and less disruption than SSRIs (Hicks et al., 2002).”
From Antidepressants and their effect on sleep (2005) · cites this paper as Hicks et al., 2002
The Results and Discussion report increased total sleep time and less sleep disturbance with nefazodone than with paroxetine early in treatment. The Conclusions say this advantage diminished after the first two weeks, and the Clinical Implications report no difference in sleep quality by eight weeks. The paper does not establish that nefazodone has among the best sleep outcomes of any antidepressant or that it frequently outperforms SSRIs as a class. Page numbers were not provided in our copy's passages. (LLM, conf=0.86)
Experimental — accuracy not yet measuredREM sleep was shown to be significantly more suppressed with paroxetine than nefazodone, and subjective sleep ratings showed greater improvements with nefazodone.
“REM sleep was shown to be significantly more suppressed with paroxetine than nefazodone, and subjective sleep ratings showed greater improvements with nefazodone.”
From Antidepressants and their effect on sleep (2005) · cites this paper as Hicks et al., 2002
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- Authors
- Hicks, J. A., Argyropoulos, S. V., Rich, A. S., Nash, J., Bell, C. J., Edwards, C., Nutt, D. J., & Wilson, S. J.
- Affiliations
- University of Bristol (GB)
- Corresponding author
- Hicks, Jane A.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2002-06
- Volume
- 180
- Issue
- 06
- Pages
- 528-535
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2113769474
- Cited by
- 84
- References
- 1
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2019: 1 · 2018: 1 · 2017: 1 · 2015: 2 · 2014: 8 · 2013: 2 · 2012: 2
- FWCI
- 7.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion)
- Explore Bristol Research (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- nefazodone, paroxetine, depression, sleep quality, antidepressant side effects, REM sleep suppression, sleep efficiency, selective serotonin reuptake inhibitors, 5-HT2 receptor antagonist, outpatients
- MeSH terms
- Adolescent, Adult, Analysis of Variance, Depressive Disorder, Double-Blind Method, Female, Humans, Male, Middle Aged, Outpatients, Piperazines, Sleep, Sleep, REM, Triazoles, Selective Serotonin Reuptake Inhibitors, Paroxetine, Antidepressive Agents, Second-Generation
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