Many clinical anecdotes and an experimental study have reported intensification of dreaming by the selective serotonin-reuptake inhibitors (SSRIs). However, no published neurochemical dream model invokes serotonin as a dream-promoting neuromodulator or accounts for serotonergic dream enhancement. An experimental study of normal volunteers showed that, although SSRI treatment decreased dream recall frequency, several subject-rated dream-intensity measures were greater during steady-state drug administration compared with pre-drug baseline and early drug treatment. Additionally, such subject-rated dream intensity as well as dream report length and judge-rated bizarreness were greater during acute discontinuation than during pre-drug baseline and drug administration periods. Nightcap ambulatory monitor data showed increased REM latency during treatment and increased REM density during acute discontinuation, indicative of SSRI-induced REM suppression and REM rebound following drug discontinuation, respectively. The bulk of pharmacological evidence suggests that drugs that enhance serotonergic neurotransmission lighten sleep. Sleep-disruptive effects of SSRIs are accompanied by electroencephalographic and electromyographic signs of brain activation, abnormally prominent eye movements in NREM sleep, and REM rebound following drug discontinuation. Explanations of SSRI-induced dream intensification suggested by these findings include, respectively, generalized brain activation during sleep, enhanced NREM dreaming, and within-night REM rebound. Additional clues as to potential causes of serotonergic dream enhancement are provided by: (i) the cellular pharmacology of hallucinogens that act on 5-HT 2A receptors, (ii) the phenomenological and functional neuroimaging effects of serotonergic hallucinogens, and (iii) putative neurophysiological mechanisms of lesionrelated complex hallucinosis.


NREM Sleep SSRI Treatment Dream Recall Charles Bonnet Syndrome Dream Recall Frequency 
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Copyright information

© Birkhäuser Verlag/Switzerland 2008

Authors and Affiliations

  • Edward F. Pace-Schott
    • 1
  1. 1.Harvard Medical School, Division of Sleep Medicine, Department of PsychiatryBeth Israel Deaconess Medical CenterBostonUSA

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