Effects of long-term administration of nicotine and fluoxetine on sleep in depressed patients

Background

The long-term effects of transdermal nicotine and fluoxetine on sleep and major depression were investigated.

Methods

Two independent groups of 12 nonsmoking patients with major depression (Hamilton Rating ≥18) served as subjects. The first group received transdermal nicotine (17.5 mg) while the second group received an oral dose of 20 mg/day of fluoxetine, 5 days weekly for 6 months, 3 days weekly at month 7 and 1 day/week at month 8. From the 9^th to the 14^th month, once a week a patch without nicotine and an oral placebo substituted nicotine and fluoxetine. Polysomnographic recordings were conducted and depressive symptoms evaluated at baseline and on a monthly basis during medication and during withdrawal.

Results

Nicotine diminished wakefulness and stage 1 and increased REM sleep latency and slow wave sleep throughout the study. A small decrease of REM sleep duration was observed upon nicotine withdrawal. Fluoxetine increased wakefulness, stage 1 duration and REM latency and decreased the sleep efficiency index. Both nicotine and fluoxetine improved mood according to HRS-D scores.

Conclusions

Nicotine and fluoxetine showed equivalent antidepressant efficacy; however, important differences in sleep parameters were observed between nicotine and fluoxetine, both during their administration and following withdrawal.