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Desperately Seeking Serotonin
Submit responseThe authors suggest other factors in addition to leptin and ghrelin may be involved in the change in appetite from sleep curtailment (1). Of special significance in this study was the craving for foods of high carbohydrate content (2). Serotonin deficiency has long been linked with carbohydrate craving (3). A good night's sleep produced by the sedative- hypnotic trazodone has been shown to curb carbohydrate craving and in my clinical experience facilitates significant weight loss (4). Trazodone (a serotonin modulator) appears to improve the depth and restorative quality of sleep which influences central autonomic functions that likely affect ghrelin and leptin (5). The SSRI's do not produce this effect.
Trazodone deserves to be considered for obese patients with disturbed sleep manifested by middle of the night awakening, snoring, sleep apnea and daytime fatigue. It should also be the subject of controlled studies to justify it's more general acceptance as therapy for stressed, carbohydrate craving, obese patients who are also likely sleep deprived but may not complain of it.
References 1. Flier,J.S.,Elmquist,J.K. A good night's sleep: future antidote to the obesity epidemic. Ann Intern Med 2004; 141 885-886 2. Speigel,K.,Tasali,E.,Penev,P.,Van Cauter,E.Brief Communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite Ann Intern Med 2004;141: 846-850 3. Wurtman,R.et al.-Carbohydrate craving in obese people: supression by treatments affecting serotoninergic neurotransmission. Int J Eating Dis 1981; 1:2-15 4. Ezrin,C.,Caron,K.L. Desperately seeking serotonin,pp 45-50 in Your Fat Can Make You Thin, New York; McGraw-Hill 2001 5. Ware,J.C..Pittard,J.T. Increased deep sleep after trazodone use: a double-blind placebo controlled study in healthy young adults. J. Clin Psychiatry 1990;51:9(suppl)18-22