Sertraline Associated with REM Sleep Behavior Disorder: A Case Report

Abstract

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. 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. 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.