Relative frequency of drug-induced sleep disorders for 32 antidepressants in a large set of Internet user reviews.

STUDY OBJECTIVES: It is known that antidepressant drugs can induce sleep disorders in patients, but little data exist about high or low-risk molecules. The aim was to study the frequency of antidepressant drug-induced sleep disorders (DISD) by molecule. METHODS: 77,391 patient comments for 32 antidepressant drugs were collected from drug review websites and screened for DISD. Association between drugs and nightmare disorder, restless legs syndrome, sleep paralysis, sleep terrors, sleep-related hallucinations, or sleep walking was expressed as relative proportion [proportional reporting ratio (PRR)]. A detailed analysis of the content of the dreams was also carried out. RESULTS: Amitriptyline, doxepin, fluvoxamine, mirtazapine, nortriptyline, trazodone, venlafaxine, and vilazodone were associated with a greater frequency of DISD compared to other antidepressants. Vilazodone heavily increased the probability of developing 5 of the 6 studied DISD (PRR 3.3 to 19.3) and mirtazapine increased the probability of developing 4 DISD (PRR 2.4 to 6.4). Bupropion and citalopram were associated with lower probabilities for 5 DISD (PRR 0.2 to 0.7). Sentiment analysis showed that patients described disturbing dreams for vilazodone or mirtazapine and strange but less negative dreams for bupropion, citalopram, or duloxetine. CONCLUSIONS: Relative frequencies of sleep disorders were obtained for a vast panel of antidepressant drugs through an original analysis of user's drug reviews on drug rating websites. Our results could guide clinicians in the appropriate choice of antidepressant drugs for high DISD-risk patients in need of such treatment. These results may however be cautiously taken, considering the uncertain reliability and generalizability of web-based data.

Memantine misuse and social networks: A content analysis of Internet self-reports.

PURPOSE: Memantine is a N-methyl-D-aspartate (NMDA) receptor antagonist currently used for moderate-to-severe Alzheimer's disease. Although the risk of memantine abuse is very low, other NMDA receptor antagonists, such as phencyclidine and ketamine, are well known to drug users. The purpose of this study was to collect data on social networks in order to identify unexpected forms of memantine abuse. METHOD: A Google Trends search was used to highlight reddit.com as a major source of social discussions about memantine. Self-reported users experiences posted on reddit.com were recorded and sorted using representative keywords. RESULTS: From 2010 to November 2019, 307 topics citing memantine were identified on reddit.com and 136 users experiences extracted from the topics were recorded. The main use identified was "self-medication" based on off-label uses of memantine such as anxiety, depression, attention-deficit hyperactivity disorder, or obsessive-compulsive disorder (n = 87 reports), followed by nootropic (42) and recreational (39) uses. The average reported doses for acute and chronic uses were 156 ± 110 mg and 23 ± 24 mg respectively. For chronic use, the average duration was 15 ± 29 weeks. Most chronic users (77 out of 100) reported at least one side effect. CONCLUSION: Memantine misuse seems to be a growing phenomenon. Beyond expected use for recreational purpose; the main uses identified on reddit.com were not reported in the medical literature. Off-label uses and nootropic purposes seemed to be key features of memantine misuse.