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    Does Wellbutrin induce REM sleep behavior disorder?

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Posted on Wed, 26 Jul 2017 in Brain and Spine
Question: I have questions about the connections between antidepressants, REM sleep behavior disorder, and Parkinson’s and other motor disorders. Let me give some background information: About 10 years ago, when I had a romantic partner (and I was in my late 20s and early 30s), I was on both Celexa and Wellbutrin for anxiety. My partner noted that I often punched and kicked in my sleep. I was somewhat aware of it. It seemed to correspond to me punching or kicking in a dream. A while ago, I stopped the Celexa, and to my knowledge, I was not doing this in my sleep. However, I have not had a romantic partner in a while. I recently went back on a low dose of the Celexa. It appeared to be really helping with my anxiety. (I was always taking it for anxiety, not depression.) However, this morning, I had a dream where I was kicking and I’m pretty sure I actually kicked in real life. I once many years ago, tried to do a sleep study but couldn’t get comfortable and fall asleep. Just one a few more pieces of information: My dad and uncle had spinocerebellar ataxia (SCA), but no other relatives of mine have had it. I believe my dad also had the same punching/kicking issues at night. I do not have any other neurological symptoms that I’m aware of, although at rest my hand has never been very steady. This has been the case for as long as I remember, though (I think at least back to high school). I also grind my teeth at night although I’m pretty sure that’s due to stress and is worse if I have caffeine. So here are my questions:
A)     Should I try again to do a sleep study?
B)     Does it sound like I have REM sleep behavior disorder?
C)     I know REM sleep behavior disorder can be linked to Parkinsons but I also ready that it’s not known if that’s the case in younger adults with antidepressant-related REM sleep behavior disorder. The articles I read on this were about 10 years old and I was wondering if there was any updated information. Also, could there be a concern about this being an early signal of my possibly developing SCA? Or if I stop the Celexa and this goes again away, should I not worry about it?
Thanks for all your help.
doctor
Answered by Dr. Erion Spaho 1 hour later
Brief Answer:
Get the sleep study done.

Detailed Answer:
Hello and thanks for using HCM.

I have read your question and understand your concerns.

Besides neurological examination, a sleep study is an examination to evaluate REM sleep behavior disorder.

It seems to be REM sleep behavior disorder, and in some cases, this kind of disorder is linked to neurodegenerative disorders such Parkinson's, multiple system atrophy, dementia.

In the other hand, REM sleep behavior disorder may be caused by antidepressants, so, in your case, in my opinion, Celexa is probably causing it, not a neurodegenerative disorder and you shouldn't worry about if it stops after stopping Celexa.

Clinically, since there are no issues with coordination of gait and poor coordination of hands, speech, and eye movements, SCA is very unlikely.

Shaking of the hand may be related to anxiety and does not mean that you are suffering from SCA, however, since there is a possible heredity about spinocerebellar ataxia, genetic testing, and brain MRI is necessay to exclude it.

Hope you found the answer helpful.

Let me know if I can assist you further.

Take care.


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Erion Spaho 17 hours later
Thanks for your reply. I’ve actually been re-thinking my symptoms since I wrote to you and I realized a few things. I’m not sure how much this changes your interpretation, and I probably need to actually see a neurologist. Please let me know what you think after reading the following.
A)     Starting 1 or 2 months ago, I’ve had a slight feeling that I didn’t have the same complete control of my legs as normal on stairs or on the treadmill. It felt more like 98% control. I assumed this was just my anxiety and I was being ridiculous. At times, I worried my feet might hit each other and trip me on the treadmill although nothing close to that ever happened.
B)     Also, about 1 or 2 months ago, I noticed that I couldn’t keep my DSLR camera with one of the lenses as steady as I used to. (It’s called a prime lens and is lighter than all my other lenses.) If I use a heavier lens, I can keep the camera steady. At the time, I thought there was just a problem with the lens.
C)     I believe both A and B above started a little before my doctor and I increased the Celexa dose but I’m not certain about the timing. I was definitely already on a very low dose of Celexa (and on Wellbutrin) then but around this time, we slightly increased the Celexa. I think the increase was slightly after the onset of A and B but I’m not sure.
D)     I’ve noticed for many years that sometimes, as I’m falling asleep, I will have a moment where I twitch or jump. This never kept me up though and wasn’t something I thought was serious.
E)     My dad and uncle both had debilitating spinocerebellar ataxia and this condition terrifies me. I’ve had other “episodes” in the past where I thought I was developing the condition but neurological examination and MRI revealed I was fine, and I believe the symptoms then were anxiety-driven.
F)     I’m still able to do everything in terms of daily functioning. However, I have felt just a little off in terms of coordination of my limbs since yesterday. I’ve been focusing on them quiet often and I have no idea if this is just anxiety. I don’t believe I have any other possible SCA symptoms like problems with speech or eye movements.
Basically, what I want to know is whether I’m developing a neurological disorder, whether this is just anxiety, or whether this is a Celexa/Wellbutrin side effect. I don’t know if it’s possible for you to say without an examination but I wanted to share all of the above info. Thanks. I just wanted to add regarding point B, I'm pretty sure that my hand shaking is worse now than it used to be in general - not just with that camera lens. It's both hands although I think the right is worse. For decades, I haven't had steady hands but I'm pretty sure they're worse now.

I'm sorry I didn't provide all the information from the last two replies in the first one. I wasn't fully aware of it or thinking about it at the time. Actually, I just looked at the dates of my pictures to see when I became less steady with that lens and the date of the Celexa prescription. They're very close. I can't tell for sure whether the increased hand shakiness came before or after the prescription. I see that my pictures with that lens were very sharp (so there was no problem) May 11, 2017 but that was the last time I used the lens for a while. I believe in late May or early XXXXXXX we increased the Celexa prescription.
doctor
Answered by Dr. Erion Spaho 19 hours later
Brief Answer:
Just episodes that don't point towards specific conditions.

Detailed Answer:
Welcome back and thanks for the additional information.

It is a little difficult to be precise without medical examination, and our opinion is informative and cannot replace your Doctor's advice, however, I think that symptoms and issues you refer are just episodes and don't point towards any specific conditions.

Celexa may be one of the possible causes, anxiety also.

About worsening of tremor, getting evaluated by a Neurologist should give the necessary data to understand better this issue.

In general, spinocerebellar ataxia consists on a constellation of symptoms and progresses more rapidly.

Hope you found the answer helpful.

Take care.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Erion Spaho 4 hours later
Thanks for all of that info. Just one clarification question. Did you mean that SCA progresses more gradually (not rapidly)?
This morning, I was thinking about the fact that I didn't notice anything unusual in April or even early May but then in XXXXXXX there was noticeable blur in my pictures. I was actually thinking that was too rapid a change to be SCA.
doctor
Answered by Dr. Erion Spaho 21 hours later
Brief Answer:
Progression means new symptoms appear too.

Detailed Answer:
Hello again.

Progression of SCA is not so gradual, is more rapid when first symptoms are evident, you have no other symptoms besides tremor that may point towards SCA.

Progression means onset of new symptoms and worsening of actual symptoms if any.

Hope this helps.

In good health.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

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