The Effects Of Venlafaxine And Mirtazapine On Sleep In Depressed Patients And The Relation Of These Effects And Curative Effect

Objective: 1,To explore the effects of venlafaxine and mirtazapine on polysomnogram and subjective sleep quality in depressed patients.2,To investigate the relation of the polysomnographic parameters and their change after treatment and the curative effect of drug, and try to find those polysomnographic parameters that can predict the curative effect of drug.Methods: polysomnogram assessments were conducted in 30 normal controls and 60 depressed subjects,then the depressed patients were divided into venlafaxine group (group I) or mirtazapine group(group II) randomly. All the patients were treated for 6 weeks,then the polysomnographic parameters and subjective sleep quality were compared with those before treatment. Depressed severity degree was evaluated by using Hamilton Depression Scale(HAMD), and the subjective sleep quality was evaluated by using the Pittsburgh Sleep Quality Index (PSQI) HAMD sleep disturbance factor total score. The reduction rate of HAMD total score was calculated to evaluate the effect of drug. Results: 1,Compared with the control group , the patient group showed a number of abnormal polysomnographic parameters in sleep process, sleep structure and REM sleep. 2,The effects of drugs on PSG: After treatment with venlafaxine,the group I showed increased number of awakening and awakening-asleeping ratio, decreased sleep efficiency, increased percentage of Stage 1 sleep, reduced REM sleep time and percentage, prolonged REM sleep latency, decreased REM activity and intensity (P<0.05) ,and the group II showed reduced sleep latency, decreased number of awakening and awakening-asleeping ratio, increased sleep efficiency and decreased percentage of Stage 1 sleep,but the REM sleep parameters were not changed remarkably. 3,After treatment ,the HAMD total score and the PSQI total score of the two groups were less than those before treatment, and the difference was significant(P<0.05).Moreover, The difference between the group I and the group II was not significant(P>0.05). 4,The reduction rate of the HAMD total score has no correlation with the change rate of all the polysomnographic parameters (P>0.05) .5,If the reduction rate of the HAMD total score was higher than 50%,the treatment was considered effective. If the reduction rate was lower than 50%,the treatment was considered ineffective. Then the polysomnographic parameters of the effective group were compared with those of the ineffective group. The delta sleep rate of the ineffective group was lower than that of the effective group (P<0.05) ,and the difference in the other parameters between the two groups was not significant(P>0.05).Conclusions: 1,Antidepressant drugs probably have other important antidepressant mechanism in addition to inhibiting REM sleep ,and inhibiting REM sleep is not the requirement of effective treatment 2,The effects of antidepressant drugs on the polysomnogram and on the subjective sleep quality in depressed patients are probably discordant ,so when The effects of antidepressant drugs on the polysomnogram are investigated ,it can reflect betterly the characteristics of antidepressant drugs to combine the subjective sleep evaluation.3. The effects of antidepressant drugs on the polysomnogram in depressed patients have no correlation with their curative effect .The abnormal time course of slow wave sleep can hint the curative effect of antidepressant drugs,and the delta sleep rate can be a parameter that can predict the curative effect of antidepressant drugs.