Hello, dogboy1995-ga!
Your question jumped out at me immediately. I had some periods in the
past when Prozac was very helpful to me. Unfortunately, my dreams
became so vivid and disruptive that I eventually reduced the dosage
and came off the medication altogether since I no longer needed it.
There is definitely evidence that many SSRI's include vivid dreaming
both as a side-effect, and as a result of withdrawal. Traumatic
experiences, which you have mentioned, can also result in recurring
nightmares which may also be helped by therapy. From your question, I
am not clear whether the onset of the vivid dreams coincide with the
initiation of antidepressant therapy (Prozac and Wellbutrin), or
whether they were occurring after the traumatic incident and before
the medications were prescribed as a treatment.
In either case, you might want to consider two routes to help reduce
the frequency of your nightmares:
1. Speak to your physician about the possibility of switching to
another SSRI that might work better for you, or possibly reducing the
dosages.
2. Consider some form of cognitive therapy to help you with your
recurring nightmares. The links to "imagery rehearsal therapy" below
are quite interesting.
Some of the references I have cited are anecdotal, but they should not
to be ignored, as patients are the best measures of side effects. I
have also compiled some references concerning the relation of Prozac
and Wellbutrin to PLMD. Finally, I have provided some references for
therapeutic treatment for nightmares in case you would like to pursue
that path, which could be extremely helpful.
Finally, before you proceed..please remember the disclaimer at the
bottom of this page:
"Answers and comments provided on Google Answers are general
information, and are not intended to substitute for informed
professional medical, psychiatric, psychological, tax, legal,
investment, accounting, or other professional advice."
==================================================
A general overview on nightmares and their causes
==================================================
From "Nightmares and Disorders of Dreaming," by J.F. PAGEL, M.D.
American Family Physician. April 1, 2000
http://www.aafp.org/afp/20000401/2037.html
Abstract follows, but please read entire article!
"Dreams occur during all stages of sleep. Nightmares are common. They
can be associated with poor sleep and diminished daytime performance.
Frequent nightmares are not related to underlying psychopathology in
most children and in some "creative" adults. However, recurrent
nightmares are the most defining symptom of post-traumatic stress
disorder and may be associated with other psychiatric illnesses. Night
terrors are arousal disorders that occur most often in children and
usually occur early in the sleep period. Patients with
rapid-eye-movement behavior disorder often present with nocturnal
injury resulting from the acting out of dreams. Dream disorders may
respond to medication, but behavioral treatment approaches have shown
excellent results, particularly in patients with post-traumatic stress
disorder and recurrent nightmares."
============================
Prozac and Vivid Dreaming
============================
From "Long-Term Side Effects Surface With SSRIs." Author: Carl
Sherman, Contributing Writer. Clinical Psychiatry News 26(5):1, 1998
http://www.antidepressantsfacts.com/LongTermSSRI.htm
"Significant insomnia affects 15%-20% of patients taking SSRIs, twice
the rate with placebo. Polysomnography has consistently found that
these drugs cause activation during the night: In addition to
insomnia, bruxism, sweating, and periodic limb movement are common.
* Vivid dreams and nightmares also occur.
With ongoing treatment, increasing numbers of patients report lethargy
and fatigue, he said."
==
From "Prozac, Zoloft, Paxil, Luvox, and Similar Drugs: Vital
Information." Pain And Stress Center.
http://www.painstresscenter.com/mall/Prozac.html
"According to research reported by Ann Blake Tracy, Ph.D., Prozac and
related drugs cause a drastic reduction in REM sleep and many
individuals on Prozac start experiencing vivid nightmares. Depriving a
person of enough REM sleep over time can cause the reaction of the
person going into an REM sleep state while awake.(16) But there is one
other factor that is critical in understanding the whole picture.
Normally, when asleep, the muscles are weak and more or less
paralyzed. You may dream that you are running or moving, but your
muscles are still. This is due to a built-in mechanism that causes a
person's muscles to remain weak and still during sleep. A study in
1989 showed this paralysis of the muscles during sleep to be related
to a particular neurotransmitter.17 This mechanism can apparently be
bypassed by a person on drugs like Prozac and he can appear to be
alert and awake but actually be in a deep sleep state.
==
From "The Tricky World of Antidepressants." (Sources: National
Depressive and Manic-Depressive Association, Brian Doyle, M.D., Dean
MacKinnon, M.D., Bruce S. Victor, M.D.)
http://cancerresourcecenter.com/articles/article04.html
"For example, if you're depressed, anxious, irritable and can't sleep,
you might do better on Paxil than Prozac. Paxil can be mildly
sedating, while Prozac can have the opposite effect. If, on the other
hand, you're depressed, lethargic and have trouble getting out of bed,
Prozac may make more sense."
"Here are some common side effects of antidepressants and ways to handle them.
Insomnia: "Take medication in the morning rather than the evening, or
ask your doctor about adjusting the dose, changing the medication or
adding another drug."
Other sleep disturbances: "All SSRIs, at least initially, tend to make
people sleep lightly and have *** more vivid dreams. *** These side
effects often improve with time. If they don't, talk with your doctor
about a change in dose or medication."
==
From "Readers on Prozac."
http://www.stressdoc.com/readers_take_on_prozac.htm
"Hi Mark, I just wanted to let you know I have been depressed and
taking 40mg of Prozac for three years (along with therapy weekly). The
only side effects I had were appetite loss and vivid dreams. I am very
fortunate to have found a medication that helps me. My depression has
greatly decreased and I'm able to carry out a "normal" life."
==
From "ARE ANTIDEPRESSANTS THE SUPERIOR TREATMENT?" Category: Neurochemistry
Term Paper Code: 935
http://sulcus.berkeley.edu/mcb/165_001/papers/manuscripts/_935.html
"The SSRIs were expected to generate less side effects than the older
antidepressants such as the TCAs. However, a recent study found that
120f patients discontinued their SSRI treatment because of adverse
effects such as dizziness, lethargy, nausea, vivid dreams,
paresthesia, lowered mood and irritability (Antonuccio et al. 1999).
==============================
Wellbutrin and Vivid Dreams
==============================
See following threads on "Wellbutrin and dreaming." from RX List:
"I have been on Wellbutrin for three months now and have recently
started to experience extremely vivid dreams that seem to last much
longer than normal. Their nature is usually nightmarish, but not in
the sense that I am scared, more in the sense that they are vibrant
and on the bizarre side. I have also experienced sudden awakening from
a dream where the dream is still lingering for what seems like a 7-8
seconds after I have woken...
http://www.rxlist.com/rxboard/wellbutrin.pl?noframes;read=942
Re: Wellbutrin and dreaming
http://www.rxlist.com/rxboard/wellbutrin.pl?noframes;read=513
=
From the "Ask a Patient" website concerning side effects of wellbutrin:
http://www.askapatient.com/viewrating.asp?drug=18644&name=WELLBUTRIN
"At first night sweats, awakening during the night, vivid dreams and
dry mouth. All of those are gone..."
"Trouble sleeping, ears ringing, vivid dreams, slight irritability,
shakiness, loss of appetite, tired but can't sleep, sexual desire
increase, emotionless or numb. These side effects are mild and I am
hoping they will subside. From what I have read, they should and
therefore I will continue to take the medication."
"Intense dreams, nervousness, and this strange up and down feeling.
"First Week: Difficult sleeping thru the night. Vivid dreams (not bad
ones, just intense). Wake every couple of hours."
"Insomnia, VIVID dreams/nightmares,.."
====================================
Prozac and PLMD/Sleep Disturbances
====================================
"Fluoxetine-induced sleep disturbance in depressed patients." Dorsey
CM, Lukas SE, Cunningham SL. Neuropsychopharmacology. 1996
Jun;14(6):437-42.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8726754&query_hl=17
"Abnormal polysomnographic (PSG) features, most notably increased
electromyographic (EMG) tone and eye movements during non-REM sleep
have been observed during sleep in fluoxetine-treated depressed
patients. However, the relationship between these PSG features and
sleep disruption is unclear. Nine depressed patients treated with 10
to 80 mg of fluoxetine and six unmedicated, depressed patients were
studied polysomnographically on two consecutive nights during which
sleep parameters, transient arousals, and eye movements were measured.
The fluoxetine group experienced a lower-average sleep efficiency
index (SEI) and significantly more eye movements and arousals during
non-REM sleep than the control group. Eye movement and arousal counts
were significantly correlated. In addition, clinically significant
periodic limb movement disorder (PLMD) was observed in 44% of the
fluoxetine-treated group versus none of the control group. We conclude
that a higher incidence of PLMD and frequent transient arousals
associated with eye movements may be responsible in part for the
complaint of insomnia made by patients treated with fluoxetine."
==
Notice that sleep terrors are also mentioned in the following abstract:
"Prominent eye movements during NREM sleep and REM sleep behavior
disorder associated with fluoxetine treatment of depression and
obsessive-compulsive disorder." Schenck CH, Mahowald MW, Kim SW,
O'Connor KA, Hurwitz TD. Sleep. 1992 Jun;15(3):226-35.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1621023&query_hl=19
"The clinical polysomnographic (PSG) reports of 2,650 consecutive
adults studied during 41 months were reviewed retrospectively to
identify all patients treated with fluoxetine or tricyclic
antidepressants. The PSG reports of four other adult groups were also
reviewed: periodic limb movement (PLM) disorder (n = 28); sleep
terror/sleepwalking (ST/SW) (n = 54); rapid eye movement (REM) sleep
behavior disorder (RBD) (n = 70); patients with clinically
unremarkable sleep during two consecutive PSG studies (n = 30).
Standard PSG recording and scoring methods were employed. A total of
1.5% (n = 41) and 2.0% (n = 52) of patients were receiving fluoxetine
or tricyclics (amitriptyline or nortriptyline, n = 31; imipramine or
desipramine, n = 16; protriptyline or trimipramine, n = 5). A
selective association between fluoxetine and extensive, prominent eye
movements in nonrapid eye movement (NREM) sleep was detected,
utilizing Fisher's exact one-tailed statistic (p less than 0.00001 for
each comparison). The detection rates were fluoxetine, 48.8% (20/41);
tricyclics, 5.8% (3/52); RBD, 4.3% (3/70); objectively normal
sleepers, 3.3% (1/30); PLM, ST/SW, 0% (0/82). These groups had similar
mean ages (31.5-45.4 years) and gender distributions (50.0-60.7%
male), apart from RBD. The effect of fluoxetine, a potent and specific
serotonin reuptake inhibitor, on NREM eye movements is postulated to
derive from potentiation of serotonergic neurons that inhibit
brainstem "omnipause neurons", which, in turn, inhibit saccadic eye
movements, thus resulting in disinhibited release of saccades. In
addition, a 31-year-old man with obsessive-compulsive disorder
developed RBD soon after starting fluoxetine therapy, which persisted
at PSG study 19 months after fluoxetine discontinuation."
==
The following study indicated that Wellbutrin (Bupropion SR) may
actually be helpful in lessening limb movements in patients who take
antidepressants.
"Bupropion SR reduces periodic limb movements associated with arousals
from sleep in depressed patients with periodic limb movement
disorder." Nofzinger EA, Fasiczka A, Berman S, Thase ME. J Clin
Psychiatry. 2000 Nov;61(11):858-62.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11105739&query_hl=19
"Antidepressant-induced periodic limb movement disorder (PLMD) may
limit the tolerability of some antidepressant medications and
interfere with treatment response. Given the role of dopamine in PLMD
and the effects of bupropion sustained-release (SR) on central
dopaminergic function, we hypothesized that bupropion SR would not be
associated with antidepressant-induced PLMD. METHOD: In an expanded
case-series design, we compared the effects of bupropion SR, after
about 10 weeks of treatment, on measures of PLMD, depression, and
sleep in 5 depressed (Research Diagnostic Criteria) patients who also
met criteria for having pretreatment PLMD. Depression was measured
using the Beck Depression Inventory and the Hamilton Rating Scale for
Depression. Patients were considered to have PLMD if polysomnographic
recordings showed > 5 periodic limb movements/hour of sleep that were
associated with arousals from sleep. RESULTS: Bupropion SR treatment
was associated with a reduction in measures of PLMD and an improvement
in depression. CONCLUSION: These results show that bupropion SR is not
associated with antidepressant-induced PLMD. Rather, bupropion SR
treatment reduces objective measures of PLMD in depressed patients
with the disorder."
===========================================================================
Therapies to Help Reduce the Incidence of Nightmares and Disturbing Dreams
===========================================================================
Imagery Rehearsal Therapy
-------------------------
A discussion of nightmares and post traumatic stress disorder and the
suggestion of the promise of "New Dream Therapy" is discussed in the
following abstract:
"The Impact of Nightmare Treatment on Posttraumatic Stress Disorder,"
by Barry Krakow, MD., Associate Research Professor of Emergency
Medicine and Psychiatry at the University of New Mexico Health
Sciences Center, Albuquerque, New Mexico, Medical Director, UNM Sleep
Research. http://www.fortunecity.com/westwood/vivienne/598/asd-17/abstracts/Krackow-nightmare_treatment_17.htm
"Our program of "New Dream Therapy" which utilizes imagery rehearsal
in the treatment of chronic nightmares emphasizes that nightmares, in
the waking state, can be altered or changed and then rehearsed, again
in the waking state, with the result of decreased disturbing dreams.
In our previous work, we have demonstrated that not only does New
Dream Therapy reduce disturbing dreams in PTSD patients, but that it
also is associated with reductions in PTSD distress as well."
See the actual study abstract:
"A controlled study of imagery rehearsal for chronic nightmares in
sexual assault survivors with PTSD: a preliminary report." Krakow B,
Hollifield M, Schrader R, Koss M, Tandberg D, Lauriello J, McBride L,
Warner TD, Cheng D, Edmond T, Kellner R. J Trauma Stress. 2000
Oct;13(4):589-609
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11109233&dopt=Abstract
==
Read about Dr. Karakow's work in laymen's terms!
"Nocturnal perdition: personality traits offer clues to nightmares -
Insights: work health relationships parenting nutrition education
brain," by Willow Lawson. Psychology Today, July-August, 2003
http://www.findarticles.com/p/articles/mi_m1175/is_4_36/ai_104681933
==
Also see how imagery-rehearsal has been used to treat the incidence of
nightmares in veterans who experienced combat-induced post traumatic
stress:
"Imagery rehearsal in the treatment of posttraumatic nightmares in
Australian veterans with chronic combat-related PTSD: 12-month
follow-up data." Forbes D, Phelps AJ, McHugh AF, Debenham P, Hopwood
M, Creamer M. J Trauma Stress. 2003 Oct;16(5):509-13.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14584636&query_hl=25
Finding a Therapist
--------------------
If you are interested in working with a cognitive therapist on dream
imagery rehearsal, you can try contacting the Academy of Cognitive
Therapy, or looking on their referral page:
http://www.academyofct.org/Info/CertifiedMembers.asp?szparent=80&SessionID=gqkoseuus
For a Simple Start
-------------------
Since you have said that the nightmare is often recurring, you might
try this simple re-scripting exercise as a start:
From "Recurring Dream & Nightmare Resolution Exercise: Re-scripting a
dream." Dreams Foundation
http://www.dreams.ca/nightmares.htm#Rescripting
"Select a nightmare or upsetting dream which you?ve recently had
(especially if it happened this morning!) and either from the
recurring dream suggestions above or on your own, re-design a
different ending to the dream. Choose something which leaves you
feeling empowered, free and confident, and great about the new
scenario, instead of the way you felt during or after the actual
dream. Before lying down to fall asleep tonight, sit in a comfortable
position and relax your body and mind completely for a couple minutes.
It may help you to alternately tense and relax different parts of your
body, and witness instead of concentrate upon any thoughts which cross
your mind. Let it all go until tomorrow. Then, once you?re calm and
quiet, mentally visualize or remember the dream you?ve selected for
this exercise, running through as though you were watching a video,
except at the point where things begin to turn unpleasant, replace the
old ending with the new empowering one you created earlier, and
imagine it as vividly as you can, "making it up" as you go if you need
to. Make it a special point to experience the new feelings of
confidence, freedom and empowerment that your new ending gives you.
Then give yourself the clear suggestion that not only are these new
thought patterns now spreading into your waking life, but also that
tonight or some time soon you may have just such a dream, which
includes the new, more fulfilling ending. You may even suggest to
yourself that you will recognize the dream as a dream, while it?s
happening, in which case you can consciously direct it as you feel
appropriate towards a more uplifting outcome."
==
I realize that this is simply a start. As noted above, I would speak
with your physician about the possible effects your medications are
having on sleep behavior, and nightmares, specifically. Secondly, I
think it would be very prudent to find a cognitive therapist that
could work with you to redirect your internal dialogue. Cognitive
therapy is a very effective, short-term method to help guide
destructive mental pathways towards more pleasant and workable
directions.
I hope I have provided some help. Best of luck and take care!
Sincerely,
umiat
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