Dr. Bob's Psychopharmacology Tips

Vivid antidepressant dreams

From: Peter D. Kramer, M.D.
Date: Mon, 6 Mar 1995 21:41:16 -0500
Subject: Vivid antidepressant dreams

A patient of mine reported dreams on Effexor so vivid that she acted on two of them -- waking to telephone people about things that had not happened. The symptom seems to have subsided with a slight increase in dose (or perhaps just the passage of time), but she still has vivid dreams. It has been my informal obervation that in patients on TCAs, vivid dreams may be a sign of too low a dosage (REM rebound?), whereas on SSRIs the vivid dreams seem to occur at adequate or high doses.

Date: Wed, 21 Jun 1995 23:35:06 -0700 (PDT)
From: "Kristin E. Zethren" <zethren@chaph.usc.edu>
Subject: Disturbing SSRI dreams

I have found clonidine 0.1 mg nightly particularly useful for disturbing dreams. I am not aware of the mechanism involved.

Date: Thu, 22 Jun 1995 11:41:39 -0500
From: talmadge@Onramp.NET (John M. Talmadge, M.D.)
Subject: Disturbing SSRI dreams

I have had excellent results with surprisingly low doses of imipramine in similar situations, and for the patient who does not abuse medications, sometimes a benzodiazepine like alprazolam or even diazepam in low doses is useful. Oxazepam combined with imipramine can also be a useful combination in many patients, particularly if oversedation is a problem.

Date: Thu, 7 Sep 1995 04:46:19 -0700 (PDT)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Increased dreaming on venlafaxine

Venlafaxine will often lead to vivid dreaming. The period of time during which the increased dreaming happens is often limited to 60-90 days. After the dreams normalize, more than a few patients report that they miss having their "super dreams."

While I have never prescribed it to control the vividness of dreaming, a number of patients who close to bedtime had taken cyproheptadine to overcome the sexual side-effects of venlafaxine or one of the SSRIs report that the cyproheptadine in addition to improving sex also reduced the vividness of dreams.

Date: Tue, 28 Nov 1995 11:00:07 -0600
From: Kevin Miller <MillerKB@wpogate.slu.edu>
Subject: Vivid SSRI dreams

I've often had good luck with trazodone for various sleep complaints with SSRIs, usually 25-200 mg HS. It probably augments, too, so I can't be sure if it's a separate effect or not.

Date: Thu, 29 Aug 1996 21:34:03 -0400 (EDT)
From: "Paul Luisada, M.D." <pvl2@cornell.edu>
Subject: Vivid clomipramine dreams

In our OCD program, clomipramine seems to cause bizarre dreams or nightmares about as often as any of the SSRIs: as common as ants at a picnic. Paradoxically, raising the dose seems to make them go away.

Date: Sun, 04 Apr 1999 14:26:03 -0400
From: Ivan Goldberg <Psydoc@PsyCom.Net>
Subject: Vivid antidepressant dreams

Cyproheptadine (Periactin) and guanfacine (Tenex) seem to do the best job of blocking overly vivid dreams.

Date: Sun, 04 Apr 1999 14:48:15 -0400
From: Harold Bursztajn <harold_bursztajn@hms.harvard.edu>
Subject: Vivid antidepressant dreams

Although a potentially disturbing symptom, the anxiety and sleep disrupting effect of such vivid dreams can often be minimized, and therapeutic progress made, through helping the patient take a nonjudgemntal attitude toward dream content, exploring meaning and affect related to dream content, and restoring agency. A common pitfall is to rush to REM suppressing agents such as benzodiazepines, some of which can exacerbate the underlying depression and retard the recovery of autonomous functions.

Also, in many instances, such vivid dreams disappear within 2-4 weeks or as the dosage increases. Part of the informed consent process, which is very helpful from a therapeutic alliance standpoint, as well as effective, state sensitive psychopharmacology practice, is to let patients know the risk of and anticipate as a potential side symptom both vivid dreams and dream suppression when beginning antidepressants.

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