RBD, Antidepressant Medications, and Psychiatric Disorders

Abstract

Idiopathic RBD (iRBD), co-morbid psychiatric illnesses, and the use of psychotropics have been increasingly reported in the literature. Among the iRBD patients, depression was found to be a common co-morbid condition. Cohorts of iRBD patients reported that those taking antidepressants were associated with significant abnormalities of early neurodegenerative markers. In a Chinese cohort, depression was found to have an increased risk of conversion to Parkinson’s disease. On the other hand, RBD symptoms have been reported in patients with psychiatric illnesses (pRBD), such as depression and post-traumatic stress disorders. This pRBD group of subjects was mostly of younger age, a higher prevalence of female gender, albeit they had a similar degree of sleep-related injuries to that of typical iRBD. While the previous literature used to regard it as an iatrogenic condition induced by antidepressants, more evidence from case-control studies, cohort studies and neuroimaging results suggested that it could be a complex condition. Apart from the drug effect, it is likely that the psychiatric illnesses per se, with a possibility of underlying neurodegeneration, could contribute to the development of RBD symptoms. Further study will need to determine the outcome of pRBD, their underlying neural circuitry, and neurotransmitter abnormalities.