Can Paxil cause nightmares? (+1 cases)

In this article, we will discuss if Paxil can cause nightmares. We will also examine the research studies confirming the possibility of nightmares and what you can do afterwards. Paxil is frequently prescribed for depression and anxiety disorder.

Can Paxil cause nightmares?

Yes, Paxil may cause nightmares. These nightmares can occur anytime during treatment.  Paxil rarely causes nightmares, but it can induce nightmares when combined with other neuroactive medicines or underlying brain dysfunction. 

Nightmares and hallucinations caused by Paxil are a rare but dangerous side effect. They can not only be painful, but they can also change the clinical picture of depression and increase the state of confusion.

How can Paxil cause nightmares?

Apart from the change in serotonin level, Paxil also affects REM (rapid eye movement) sleep. The majority of dreams occur during this restorative time of sleep, which is regarded to be important for learning, memory, and mood.

Most of the literature suggests that Paxil inhibits REM sleep. If this is the case, the patient should experience fewer dreams rather than more. However, some people will indeed experience very vivid dreams, which might also include horrific nightmares.

It is crucial to understand that mental health issues such as anxiety and depression lead to sleep disorders and can contribute to intensity and the frequency of nightmares. So sometimes, the underlying factor can be depression itself which causes stress on the brain to induce nightmares.

Which factors increase the incidence of a nightmare with Paxil?

Apart from Paxil, some other factors can also cause nightmares, including:

• Trauma: physical abuse, accident, or some injury can increase the incidence of nightmares.
• Post-traumatic stress disorder (PTSD): if a patient has not recovered from a past traumatic event, this can cause vivid dreams and depression in the patient.
• Sleep deprivation: nightmares are also common if the patient is not getting enough sleep or has changed their sleeping schedule.
• Substance misuse: consuming alcohol or substance abuse can trigger nightmares at night.
• Scary movies: sometimes watching a scary movie before bedtime can be a reason for having bad dreams.
• Medications: some medications can also cause nightmares, including beta-blockers, antimicrobials, drugs for Parkinsonism, stimulants, blood pressure medicines, and other antidepressants.

When to consult the doctor?

Talk to your doctor about your nightmares, especially if they are accompanied by hallucinations. Your doctor will reduce your dose or find an alternative antidepressant therapy.

It is important to know that Paxil withdrawal can also lead to nightmares. The patient should report past frequency of nightmares, other prescription drugs, or consumption of alcohol or other drug abuse.

What does the research suggest?

In a case report, a patient began having nightmares about being persecuted by a religious sect on day 10 of taking Paxil. These nightmares became daydreams in which she walked the streets to avoid her persuaders. Discontinuing Paxil reduced these nightmares (1).

Increasing the dose of Paxil from 20 mg/day to 30 mg/day caused nightmares in a female patient. After 2 weeks, she saw ghosts and wild animals chasing her. Reducing the dose did not result in symptom relief, hence Paxil was discontinued (2).

Does Paxil help in dream recall?

Paxil reduces dream recall frequency more than the other antidepressants. These symptoms can happen during the therapy and when the patient abruptly discontinues. However, it can increase dream content intensity, including (3):

• Memorability,
• emotional intensity,
• visual intensity,
• sound intensity.

Can Paxil-induced nightmares cause REM sleep behaviour disorder?

Paxil has been reported to activate REM sleep behaviour disorder (RBD) and nightmares. In a case report, a patient taking Paxil reported leg kicking while sleeping. This was accompanied by arm swinging and thrashing. 

The patient indicated that these episodes were accompanied by dreams, with a frequent theme of violence or being attacked. The patient was also vocal during these nightmares. Paxil discontinuation fixed the problem (4).

Can Paxil induce nightmares during drug withdrawal?

Sometimes, Paxil withdrawal symptoms increase the oddness of the dreams and make the nightmares even more horrible. It also makes it difficult for the patient to describe it in detail. Other related symptoms might include:

• hallucinations,
• delusions,
• increased sweating,
• irregular sleeping pattern.

What are the tips to minimize the occurrence of nightmares?

• Establish a good bedtime routine.
• Adapt guided mindfulness practices,
• Do breathing exercises,
• Avoid the use of mobile phones before bed,

How to relax after a Paxil-induced nightmare?

• Relax your face and muscles,
• Drop the shoulders and hands to the side,
• Exhale, allowing the chest to relax,
• Smell a scented item, like an essential oil, candle, or lotion.

Conclusion

We discussed the nightmares induced by Paxil as a side effect and the tips to relax after a nightmare. You should always consult your doctor if your dreams become vivid. Your doctor will adjust the dose. I would recommend using Paxil at daytime to reduce the occurance of nightmares.

References