J Clin Neurol.  2020 Apr;16(2):261-269. 10.3988/jcn.2020.16.2.261.

Comorbid Depression Is Associated with a Negative Treatment Response in Idiopathic REM Sleep Behavior Disorder

Affiliations
  • 1Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
  • 2Department of Neurology, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 4Department of Neurology, Ajou University School of Medicine, Suwon, Korea.
  • 5Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
  • 6Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
  • 7Protein Metabolism and Dementia Research Center, Seoul National University College of Medicine, Seoul, Korea.
  • 8Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 9Minnesota Regional Sleep Disorders Center and Department of Psychiatry, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA.

Abstract

Background and Purpose
The first-line medications for the symptomatic treatment of rapid eye movement sleep behavior disorder (RBD) are clonazepam and melatonin taken at bedtime. We aimed to identify the association between depression and treatment response in patients with idiopathic RBD (iRBD).
Methods
We reviewed the medical records of 123 consecutive patients (76 males; age, 66.0±7.7 years; and symptom duration, 4.1±4.0 years) with iRBD who were treated with clonazepam and/or melatonin. Clonazepam and melatonin were initially administered at 0.25–0.50 and 2 mg/day, respectively, at bedtime, and the doses were subsequently titrated according to the response of individual patients. Treatment response was defined according to the presence or absence of any improvement in dream-enacting behaviors or unpleasant dreams after treatment.
Results
Forty (32.5%) patients were treated with clonazepam, 56 (45.5%) with melatonin, and 27 (22.0%) with combination therapy. The doses of clonazepam and melatonin at followup were 0.5±0.3 and 2.3±0.7 mg, respectively. Ninety-six (78.0%) patients reported improvement in their RBD symptoms during a mean follow-up period of 17.7 months. After adjusting for potential confounders, depression was significantly associated with a negative treatment response (odds ratio=3.76, 95% confidence interval=1.15–12.32, p=0.029).
Conclusions
We found that comorbid depression is significantly associated with a negative response to clonazepam and/or melatonin in patients with iRBD. Further research with larger numbers of patients is needed to verify our observations and to determine the clinical implications of comorbid depression in the pathophysiology of iRBD.

Keyword

rapid eye movement sleep behavior disorder; depression; clonazepam; melatonin
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