How do you approach managing intolerable vivid dreams as a side effect of SSRIs?

There are several distinct options I go over with patients who have this side effect.

1. It often self-resolves, but can take a few (up to 6) months to resolve, and there is no guarantee. If the patient is willing to tough it out, I often have them do nothing. But, we are talking about it being an intolerable side effect…
2. Add an agent to try and block the vivid dreams. I often add a Z-drug (zolpidem, eszopiclone, zaleplon) to help patients sleep (there are some articles on these drugs enhancing the antidepressant benefits of SSRIs, but since the data are from pharmaceutical manufacturers, take it with a grain of salt. One of my old mentors, Dr. Martin Szuba, used to say that mood disorders are actually sleep disorders with a mood component). ...

Given that the dreams are described as intolerable, I would transition to an agent more favorable in terms of sleep architecture, such as vilazodone (Viibryd).