Effects of Tranylcypromine on the Sleep of Patients with Anergic Bipolar Depression

A significant proportion of patients with bipolar disorder are hypersomnolent. It is not clear if this affects response to treatment because few studies have systematically examined treatment effects on sleep in patients with bipolar depression. Reported herein are the results of what we believe to be the first study of the effects of the monoamine oxidase inhibitor tranylcypromine (average dose = 37 mg/day) on the sleep of patients with bipolar depression. Twenty-three patients with anergic bipolar depression completed sleep studies before and after pharmacotherapy. Changes in polysomnographic variables were examined using paired t-tests. The patients experienced a 40% reduction in rapid eye movement (REM) sleep time, as well as significant decreases in REM percentage, REM activity, number of REM periods, and REM intensity. REM latency was prolonged by nearly threefold. The decrease in REM sleep was accompanied by a modest (8%) reduction in total sleep time and increased “light” sleep. There was no change in sleep continuity indices or slow wave sleep. Correlational analyses suggested that antidepressant response was only weakly associated with changes in REM sleep. These findings indicate that tranylcypromine’s effects on REM sleep greatly surpass effects on sleep architecture or sleep maintenance. Moreover, effective treatment of bipolar depression did not “normalize” the hypersomnolence associated with bipolar depression. Psychopharmacology Bulletin. 2003;37(3):118-126.