Antidepressants Before an MSLT: Ask for a Written Plan

Your daytime nap-test instructions mention antidepressants, but the appointment date is already close. Call the sleep service before changing a dose. The medicine plan is part of preparing for the Multiple Sleep Latency Test, or MSLT.¹

Why the timing matters

The AASM adult protocol discusses tapering medicines that affect REM sleep or the time taken to fall asleep, followed by sufficient time off them before testing. It says the ideal duration has not been extensively studied; two weeks is considered sufficient in many patients. This is a preparation discussion with your clinicians, not a personal stop date.¹

“Washout” refers to time off a medicine before the test. It is not the same thing as the time needed to reduce the dose. Taking your usual dose until two weeks before the appointment and then stopping abruptly is not an agreed taper.

Mayo Clinic² warns that suddenly stopping an antidepressant can produce withdrawal symptoms within a day or two, including dizziness, nausea, anxiety, insomnia and vivid dreams. A clinician may recommend dose reductions over several weeks or longer. Returning depression and withdrawal can be difficult to distinguish, so report symptoms during any agreed change.²

What the 502-patient study found

A Mayo Clinic² Rochester record review covered 502 adults tested in 2014–2018; their average age was about 38, and 67% were women. Of 178 taking REM-suppressing antidepressants at assessment, 121 discontinued them before testing.³

Those who discontinued were more likely to have at least two sleep-onset REM periods than those who remained on the medicines. The reported odds ratio was 12.20, with a wide 95% confidence interval of 1.60 to 92.94. That is an association with a test finding, not a twelvefold personal chance of narcolepsy.³

Patients were not randomly assigned to stop or continue. The findings do not establish that stopping fits every patient. The center’s usual approach was two weeks off antidepressants where feasible, and six weeks for fluoxetine. Those were its procedures, not a schedule to copy.³

If continuing the medicine is the agreed plan

Ask how the report will account for it. The study authors recommend including a statement about possible drug effects when REM-suppressing antidepressants are not withdrawn.³

You can ask: “My prescriber and I agreed to continue this medicine. How could it affect the REM findings, and what would a negative test tell us?” Bring the name, dose and actual dates of any changes. Our MSLT and MWT comparison explains the different test purposes.

The play

Try this: clarify three dates

1. Confirm the test date and which clinician coordinates the medicine plan.
2. Ask whether any taper is appropriate, when it would begin and what symptoms require contact. Get the instructions in writing.²
3. Confirm what to record if a dose changes or the planned preparation cannot be completed. Contact the service before assuming the appointment can proceed.

Bring your Visit Brief

Did I Do That in My Sleep?, Chapter 3, introduces a Visit Brief holding the symptom, timeline, effect and practical constraint. Add the test date and medicine-preparation question. The book’s 14-Night Lights-Out Record can organize sleep observations; it does not supply an antidepressant taper. See the book.