Night Terrors Helped by Paroxetine

ABSTRACT & COMMENTARY
Source: Wilson SJ, et al. Adult night terrors and paroxetine. Lancet 1997;350:185.

Night terrors uncommonly affect adults, but when they do, automatisms represent a potential possibility for injury. Wilson et al describe six such patients, ranging in age from 24 to 46 years, who suffered such episodes as little as 2-3/week or as often as 2-3/night. All patients were evaluated clinically and, at night, by home applied polysomnography. One patient received 40 mg HS of paroxetine; the remainder took 20 mg, also HS. The medication stopped attacks in three persons and reduced them substantially in the other three. Withdrawal of paroxetine was shortly followed by a recurrence of the night terrors. How long clinically ingested paroxetine suppressed night terrors is not reported.

Paroxetine (Paxil) is a selective serotonin reuptake inhibitor and has proved useful in stopping panic attacks. Among other drugs, only benzodiazepines have brought success in treating night terrors. The effect tends to disappear as drug tolerance develops. Imipramine also is known to provide only temporary relief. Although this brief report is encouraging, only time will tell whether or not paroxetine will become the permanent drug of choice in treating night terrors.

COMMENTARY

A recent paper by Schenck and Mahowald (Am J Med 1996;100:333-337), although cited by Wilson et al, differs strongly with their statement that benzodiazepines fail to provide durable help to patients with night terrors. The Schenck and Mahowald report included 69 persons with sleep terrors or sleepwalking. It indicates that 1.16 ± 1.04 mg clonazepam taken 1-2 hours before desired sleep onset provided approximately 86% with complete or nearly complete relief of night terrors and somnambulism. Although no patient was able to reduce the benzodiazepine dose without relapsing, treatment was continued successfully for 3.9 ± 2.3 years, at which point the study closed.

What’s needed here is a blinded comparison of effectiveness and costs of these two drugs in the treatment of potentially injurious parasomnias of nocturnal sleep. —fp