Background:
REM sleep behavior disorder (RBD) is manifested by abnormal
motor behavior with an endurance of tone during REM sleep. Studies suggest that patients
taking Selective serotonin reuptake inhibitors (SSRIs) are at greater risk of developing
REM sleep behavior disorder.
Case Presentation:
We present a case of 39-year-old female with a past medical history of
spinal cord injury from a gunshot wound 19 years ago resulting in paraplegia, posttraumatic
stress disorder(PTSD), chronic pain, and chronic sleep problem. After sertraline
started and up-titrated to 200 mg for her anxiety, she noticed worsening of her nighttime
sleep behavior. Her mother also witnessed sleepwalking episode and doing things which
the patient had no recollection in the morning, including trying to take a bath and eat from
the refrigerator. On her follow-up appointment, her sertraline was discontinued altogether
and she was started on Escitalopram 5 mg. She tolerated the medication well, it helped
moderately with her anxiety and by the time of this case report (approximately 1 month)
patient did not report any sleep-related behavior.
Conclusion:
Since antidepressant medication is very commonly prescribed, it is important
to be cautious of physiologic changes they may induce, even if the clinical significance of
these changes is not fully elucidated. In addition, RBD may predict neurodegenerative disorders
a couple of years earlier, so it may be used as an effective early marker of neurodegenerative
diseases.
Mirtazapine for Suspected REM Sleep Behavior Disorder and Depression: A Case Report
