Sleep Disturbance Associated with an enhanced Orexinergic system induced by chronic treatment with paroxetine and milnacipran

In paper citation (Rahmadi, et al., 2011).

Mice treated with the SSRI paroxetine 10mg/kg or SNRI milancipran (30mg/kg) had their sleep recorded on day 7 and their orexinergic receptor and mRNA for orexinergic receptors quantified on day 28. Both antidepressants significantly decreased total sleep time and decreased total NREM sleep. OX1R and OX2R mRNA expression significantly increased in the hypothalamus of animals on antidepressants, as did the H1R and histidine decarboxylase mRNA expression in the frontal cortex.

Paroxetine still has an affinity for the H1R receptor of .0045*10^-7/equilibrium dissociation constant, which may be blockading the H1R receptor and thus upregulating it (Richelson, 1996). Richelson did not have the binding affinity for milnacipran in his paper.

Histidine decarboxylase is involved in the synthesis of new histamines, so the blockade of H1R receptors might promote this increased synthesis, and thus increased mRNA expression in the frontal cortex.

Orexins are synthesized in the lateral hypothalamus, so the increase in Orexinergic receptor mRNA expression might indicate that little orexin is making it back to the hypothalamus for use in a feedback mechanism. The orexins might be binding in wake-promoting areas and getting metabolized there. Increasing total orexins should increase a person's wakefulness.