Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants commonly prescribed to treat depression, anxiety, and other mental health conditions. Some of the most well-known SSRIs include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), and paroxetine (Paxil). SSRIs work by increasing levels of serotonin in the brain. Serotonin is a neurotransmitter that helps regulate mood, sleep, appetite, and other functions.
One common side effect of SSRIs is drowsiness and fatigue, especially when first starting treatment. Some people report feeling like they want to sleep all the time when they begin taking an SSRI. This has led many to wonder – do SSRIs make you sleep a lot? Below we’ll explore the research around SSRIs and sleepiness and discuss why fatigue is a common side effect.
How SSRIs Affect Sleep
SSRIs can influence sleep in a few key ways:
– They may cause sedation and drowsiness, particularly early in treatment. This can result in sleeping more overall.
– They can affect sleep architecture – the structure and pattern of sleep cycles. SSRIs may decrease time spent in deep, slow wave sleep and increase time spent in lighter stages of sleep.
– They may worsen or cause sleep disorders like insomnia, vivid dreams, nightmares, and restless leg syndrome in some individuals.
– They may improve sleep in those with depression by alleviating depressive symptoms. Depression itself often causes significant sleep disturbances.
So in summary, SSRIs do commonly cause sedation and fatigue, especially when first starting treatment. This sedation effect may translate to an increase in overall sleep time for some people. However, SSRIs can also negatively impact sleep quality by altering sleep cycles and architecture. Individual experiences vary greatly – some may find they sleep more deeply, while others find their sleep becomes lighter and more restless.
Why Do SSRIs Cause Daytime Sleepiness?
There are a few reasons why drowsiness and fatigue are common side effects with SSRIs:
– Increased serotonin levels – One of serotonin’s roles is to help regulate sleep-wake cycles. Increasing serotonin signaling typically causes drowsiness and sedation. This effect usually wears off over time as the brain adjusts to the higher serotonin levels.
– Antihistamine effects – SSRIs like paroxetine and fluoxetine have antihistamine properties. Antihistamines are known to cause drowsiness as a side effect.
– Changes in sleep architecture – While SSRIs may make it easier to fall asleep initially, they reduce time spent in restorative slow-wave sleep. This can cause daytime fatigue.
– Withdrawals from medications, drugs, or alcohol – SSRIs may be prescribed to help those withdrawing from other substances that impact sleep and energy levels like alcohol, opioids, or stimulants. Withdrawal can temporarily worsen fatigue.
– Depression improvement – As SSRIs start working, energy levels may initially worsen before improving. This temporary fatigue is sometimes called a “hangover effect.”
So in summary, multiple mechanisms related to increased serotonin, antihistamine effects, changes in sleep cycles, and secondary withdrawal effects likely contribute to sedation and sleepiness with SSRIs.
Do SSRI Side Effects Go Away?
For most people, the sedative and sleep-inducing effects of SSRIs do go away over time. In clinical studies, sedation was most common within the first 1-2 weeks of starting an SSRI. Most people adjusted to the medication within 2-4 weeks. However, some people may continue to feel persistently tired while taking an SSRI.
There are a few things that can help manage fatigue when starting an SSRI:
– Take the medication in the morning or early afternoon to avoid sleep disturbances at night.
– Start with a low dose and titrate up slowly to allow the body to adjust.
– Avoid alcohol and sedatives that could compound fatigue.
– Wait it out – most adaptation happens within 4 weeks as serotonin levels stabilize.
– Discuss switching medications or adding a stimulant with your doctor if fatigue persists beyond 4-6 weeks and impacts daily function.
So in most cases, SSRI-induced drowsiness does resolve within about a month as the body acclimates to the drug. But speak to your doctor if the side effect is excessive or long-lasting. There may be treatment adjustments that can help.
How Much More Do People Sleep on SSRIs?
It’s difficult to give an exact number on how much additional sleep SSRIs cause, since people’s responses vary greatly. But some research has looked at differences in total sleep time among SSRI users versus non-users:
– One study found SSRI users slept about 16 minutes longer on average than non-users.
– Another found people taking SSRIs for depression slept 37 minutes longer than those not taking antidepressants.
– Patients taking SSRIs for anxiety disorders slept 49 minutes longer than non-users according to one analysis.
– A meta-analysis found that across multiple clinical trials, SSRIs increased total sleep time by approximately 1 hour on average.
So based on these clinical studies, it appears SSRIs may increase total sleep time by anywhere from 15 minutes to 1 hour per night on average. For some individuals the increase could be even greater, especially when first starting treatment. However, as previously discussed, simply sleeping more does not necessarily mean better or more restful sleep.
How Long Does SSRI Sleepiness Last?
Again, there is no definitive answer, as each person reacts differently to SSRIs. But generally, the most profound sedation and need for extra sleep occurs within the first 1-4 weeks of starting an SSRI or increasing the dosage.
Most studies have found that excessive somnolence and fatigue tend to resolve within 4-6 weeks at the maximum as the body adjusts to the medication. After this initial adjustment period, the extreme sleepiness and hangover-like effects should dissipate.
However, everyone is different. A small percentage of individuals may continue to require extra sleep or feel persistently tired while taking an SSRI long-term. This side effect may last for months or even years for some. If fatigue remains problematic, consulting your doctor about adjusting the medication regimen would be warranted.
Tips for Managing SSRI-Induced Sleepiness
Here are some tips for dealing with drowsiness and fatigue from SSRIs:
– Take your SSRI dose in the morning or early afternoon to avoid sleep interference at night.
– Start with the lowest recommended dose to allow your body time to adjust slowly.
– Avoid alcohol, sedatives, antihistamines, and other drugs that add to sleepiness.
– Ask your doctor about taking a psychostimulant like modafinil to counter fatigue as needed.
– Get regular exercise and exposure to daylight – this helps regulate circadian rhythms.
– Stick to a regular sleep-wake schedule. Avoid oversleeping during weekends/days off work.
– Reduce caffeine intake, as it may amplify anxiety with some SSRIs.
– Report persistent fatigue to your doctor – they may adjust the timing, dosage, or medication choice.
– Be patient during the first 4 weeks – side effects typically improve within 1 month.
Alerting your doctor is also recommended if you feel overly sedated or sleepy while operating heavy machinery or driving on an SSRI. Switching to a more activating antidepressant may be beneficial in those situations.
How SSRIs Affect Sleep Stages
Beyond just increasing overall sleep time for some people, SSRIs also affect sleep architecture – the structure and pattern of the various sleep stages. Specifically, SSRIs appear to:
– Reduce slow wave sleep (SWS) – also called deep sleep or N3 sleep. SWS helps you feel rested.
– Increase stage N1 sleep – the lightest, most transitional sleep stage.
– Increase REM latency – the time it takes to reach the first REM cycle.
– Decrease REM density – the amount of eye movement activity during REM.
These changes to sleep stages may explain why some people don’t feel refreshed even after sleeping more on SSRIs. The composition of sleep shifts towards lighter and less restorative stages. However, research is mixed – some studies have not found major differences in sleep architecture with SSRI use. More research is still needed.
– SSRIs reduce time spent in slow wave and REM sleep.
– They increase transitions to lighter sleep stages.
– This may impair sleep quality and daytime functioning.
– However, findings on SSRIs’ effects on sleep stages are mixed across studies.
Natural Alternatives to Help With SSRI Sleepiness
For those bothered by SSRI-induced drowsiness, there are some natural supplements that may help provide a boost of energy:
– Ginseng – An adaptogenic herb that may help increase wakefulness and reduce fatigue.
– Rhodiola – A plant with anti-fatigue and energy-enhancing effects. May help counteract SSRI sedation.
– Gingko biloba – This plant extract may help combat feelings of sluggishness, brain fog, and fatigue.
– L-tyrosine – An amino acid that can help restore alertness when neurotransmitter levels are imbalanced.
– B complex vitamins – Important for energy production pathways. Deficiencies may exacerbate fatigue.
It’s best to discuss trying any supplements with your doctor, as some may interact with SSRIs. Things like staying active, avoiding naps, and maintaining good sleep hygiene can also help overcome tiredness. Addressing nutrition, exercise, stress management, and other lifestyle factors can support energy levels.
– Adaptogens like ginseng, rhodiola, and gingko may alleviate SSRI-induced fatigue and sleepiness.
– Amino acids like L-tyrosine support alertness.
– B vitamins prevent energy deficiencies.
– Non-drug approaches like diet, exercise, stress control, and sleep hygiene also help boost energy.
Comparing SSRIs and Their Effects on Sleep
While all SSRIs can cause sedation to some degree, some individual medications are more likely to induce sleepiness than others. Here’s a brief comparison of how the most common SSRIs affect sleep:
|Effect on Sleep
|Moderate sedation reported, especially initially due to long half-life. May impair sleep maintenance.
|Can cause drowsiness but generally less sedating than other SSRIs. May cause insomnia.
|Commonly causes daytime sleepiness and fatigue. Improves sleep quality in some.
|Similar to citalopram. Very sedating for some people. May disrupt sleep and cause insomnia.
|Most sedating SSRI. Significant daytime drowsiness reported, especially at higher doses.
So in summary, paroxetine and fluoxetine tend to be most sedating, while sertraline is less likely to cause sleepiness. Citalopram and escitalopram fall somewhere in the middle. However, individual reactions vary quite a bit, so these are just general tendencies.
– Paroxetine (Paxil) is the most sedating SSRI.
– Fluoxetine (Prozac) can cause prolonged sedation in some cases.
– Citalopram (Celexa) and escitalopram (Lexapro) moderately increase sleep time.
– Sertraline (Zoloft) has the least effect on sleepiness for most people.
SSRI Sleepiness in Children and Adolescents
SSRIs are sometimes prescribed to treat depression and anxiety in adolescents and children over age 6-12. However, pediatric patients seem to be even more vulnerable to sedation side effects from SSRIs compared to adults. Some research has found:
– Up to 45% of children report daytime sleepiness within the first month of starting an SSRI.
– Sleepiness is cited as one of the most bothersome side effects by children on SSRIs.
– Excessive sleep duration returns to normal after 2-3 months of SSRI therapy in most kids.
– Fatigue is worse with higher SSRI dosages. Lower doses have been suggested for children.
– Sleepiness may contribute to emotional blunting in youth on SSRIs.
Parents should be vigilant for any worrisome fatigue or apathy developing after their child begins an antidepressant. Making dose adjustments or switching medications may be warranted in severe cases of sedation or hypersomnia. Guidance from the prescribing doctor is recommended. Allowing kids to nap during the day could also exacerbate nighttime sleep disruptions.
– Sleepiness and fatigue are very common with SSRIs in children and adolescents.
– Sleep duration returns to normal within 2-3 months for most pediatric patients.
– Lower SSRI doses for children may prevent excessive sedation side effects.
– Naps during the day could compound sleep issues at night.
Risks of Oversleeping From SSRIs
While short-term somnolence from SSRIs is normal, excessive oversleeping on a regular basis does come with some risks. Potential problems associated with oversleeping on SSRIs include:
– Daytime fatigue, sleepiness, and reduced alertness
– Impaired cognition, concentration, and memory
– Mood changes like irritability, apathy, and depression
– Weight gain and metabolic changes
– Social isolation and loss of interest in activities
– Tolerance development to the sedative effects
– Sleeping in and missing responsibilities
– Insomnia at night after daytime oversleeping
Habitual oversleeping can also be a sign of underlying medical disorders like sleep apnea, narcolepsy, or thyroid dysfunction. These conditions may be unmasked or made worse by SSRIs in some cases. Overall, aiming for a healthy 7-9 hours per night without excessive daytime sleeping is ideal. Oversleeping on a frequent basis can negatively impact health and functioning.
– Daytime fatigue, weight gain, depression, and sleep disturbances may result from oversleeping.
– Sleeping too much could indicate untreated sleep disorders or medical problems.
– Staying active and disciplined helps prevent oversleeping from SSRI sedation.
Who Should Avoid SSRIs Due to Sleepiness?
While sedation from SSRIs usually subsides within 4 weeks, some people may be more susceptible to persistent drowsiness that interferes with functioning:
– Those operating heavy machinery or driving for a living – sleepiness slows reaction times.
– Healthcare workers and others needing to stay alert at their jobs.
– College students and those in intellectually demanding academics.
– Athletes, fitness instructors, and others requiring stamina.
– People with bipolar disorder – fatigue and oversleeping may indicate switching into mania.
– Those who already complain of daytime sleepiness or fatigue symptoms before starting SSRIs.
For these groups, it’s recommended to start with a less sedating SSRI like fluoxetine or sertraline. Adding a psychostimulant medication may also help restore wakefulness as needed, under medical supervision. Switching to a non-SSRI antidepressant like bupropion is another option if grogginess persists over 4-6 weeks.
– People in intellectually or physically demanding jobs require wakefulness.
– Those with bipolar disorder need cautious use of SSRIs to avoid triggering mania.
– Adding a stimulant or switching antidepressant class could prevent excessive sleepiness.
In summary, it is very common to experience increased sleepiness, fatigue, and need for extra sleep when first starting treatment with SSRIs. This temporary sedation is caused by the medications’ effects on serotonin levels and shifts in sleep architecture. While bothersome, sleep-inducing side effects generally resolve within 4-6 weeks as the body acclimates to the drug. Ongoing excessive hypersomnia or sleep duration longer than 10 hours per day could signal other underlying issues. Adjusting dosage timing, adding a psychostimulant, or changing to a less sedating antidepressant may alleviate prolonged sedation issues in some cases. Being aware of the sleepiness potential with SSRIs allows patients to plan accordingly and take steps to safely manage this temporary side effect.