Sleep disturbances are reported by more than 50% of the youth with anxiety and obsessive-compulsive disorders. Furthermore, the most effective psychopharmacologic interventions for these disorders, i.e. selective serotonin reuptake inhibitors (SSRIs) may themselves raise insomnia and tiredness/sedation as well. Yet, the danger of sleep-related problems for specific SSRIs remains poorly investigated. 

A recent study examined sleep-related adverse events (AEs) across specific SSRIs in clinical trials of youth with anxiety disorders and obsessive-compulsive disorder (OCD) using Bayesian hierarchical modelling (BHM).

The prospective, randomized, parallel-group, placebo-controlled trials that evaluated SSRIs in social, generalized, and/or separation anxiety disorder or OCD in children or adolescents, and systematically caught sleep-related AEs were included in this meta-analysis. Youth with OCD were included as they experience sleep-related problems at likewise high rates as youth with anxiety disorders, and clinicians should consider this when treating such patients. Trials of SSRIs in pediatric patients with major depressive disorder were excluded since these trials vary greatly in methodologic and depressive pathology may impact specific symptoms. A BHM was used to assess the risk of sleep-related AEs and to permit for heterogeneity across studies. 

Studies investigating SSRIs like fluoxetine, fluvoxamine, paroxetine, sertraline, and escitalopram were included. No marked sedation contrasts were observed between placebo and fluvoxamine, escitalopram, paroxetine, or sertraline. Also, no substantial insomnia differences were seen between placebo and fluoxetine, paroxetine, fluvoxamine, or escitalopram.

These findings indicate the sleep-related side effects to be associated with specific SSRIs and hold significant clinical implications. 

Combining psychological interventions with SSRIs enhances the outcomes. However, in cases where psychotherapy is not the treatment of choice, clinicians must consider the impact of SSRI choice on sleep.

Source: Journal of Child and Adolescent Psychopharmacology. 2021: 387-388.http://doi.org/10.1089/cap.2020.0169