From the Guidelines
Seroquel (quetiapine) should not be used as a first-line treatment for sleep disturbances due to its significant risks and side effects. The 2020 clinical practice guidelines from the U.S. Department of Veterans Affairs and U.S. Department of Defense, published in the Annals of Internal Medicine 1, advise against the use of antipsychotics, including quetiapine, for the treatment of chronic insomnia disorder. This recommendation is based on the lack of evidence supporting the efficacy of quetiapine for insomnia and its potential for adverse effects, such as metabolic changes, cardiac issues, and daytime drowsiness.
Some key points to consider when evaluating the use of quetiapine for sleep disturbances include:
- The medication is not FDA-approved for insomnia and is typically used off-label for this purpose
- Quetiapine can produce sedation at low doses, but its effects on sleep quality and duration are variable
- The risks associated with quetiapine, including metabolic effects and potential cardiac issues, make it a less desirable option for treating sleep disturbances
- Better initial options for treating insomnia include improving sleep hygiene, cognitive behavioral therapy for insomnia, or shorter-term use of medications specifically approved for sleep disorders
In general, quetiapine should only be considered for patients who have failed other treatments or who have concurrent psychiatric conditions that might also benefit from this medication, and even then, it should be used with caution and close monitoring 1.
From the FDA Drug Label
Somnolence was a commonly reported adverse event reported in patients treated with quetiapine especially during the 3 to 5 day period of initial dose-titration. In bipolar depression studies (up to 8 weeks), the most commonly observed treatment emergent adverse reactions associated with the use of quetiapine (incidence of 5% or greater) and observed at a rate on quetiapine at least twice that of placebo were somnolence (57%)
Seroquel (quetiapine) is associated with somnolence (sleepiness), which may be beneficial for patients with sleep disturbances. However, it is not explicitly approved for treating sleep disturbances. The high incidence of somnolence in patients treated with quetiapine, especially during the initial dose-titration period and in bipolar depression studies, suggests that it may be effective in promoting sleep. Nevertheless, caution is advised when using quetiapine for sleep disturbances due to its potential for adverse effects and lack of explicit approval for this indication 2, 3, 4.
From the Research
Effectiveness of Seroquel for Sleep Disturbances
- Seroquel (quetiapine) is an antipsychotic medication that is sometimes used off-label to treat insomnia, despite limited evidence to support its use for this purpose 5.
- The use of Seroquel for insomnia is associated with risks, including weight gain and other metabolic effects, and should be used cautiously and with appropriate monitoring for adverse effects and abuse 5.
- Cognitive behavioral therapy (CBT) is a recommended first-line treatment for insomnia, and has been shown to produce durable sleep improvements up to two years after completion of treatment 6, 7.
- Medications such as zolpidem may be used as an adjunct to CBT, but their use should be carefully considered due to the risk of adverse effects, including complex behaviors such as sleepwalking and increased suicidality 8, 7.
Comparison to Other Treatments
- Non-benzodiazepine receptor agonists, such as zolpidem, have improved safety profiles compared to benzodiazepines, but their side effects can still be significant, including dementia, serious injury, and fractures 9.
- Ramelteon has a minimal adverse effect profile and is effective for sleep-onset latency and increased total sleep time, making it a valuable first-line option for insomnia treatment 9.
- Sedating low-dose antidepressants, antipsychotic agents, and other medications may be used off-label for insomnia, but their use should be carefully considered due to the risk of adverse effects 9.
Considerations for Treatment
- The treatment of insomnia should involve a multi-disciplinary approach, focusing on implementing behavioral interventions, improving sleep hygiene, managing psychological stressors, and pharmacological therapy 8.
- Clinical inertia regarding previous prominent use of benzodiazepines and non-benzodiazepine receptor agonists will be a significant challenge for patients accustomed to their issuance, and non-pharmacologic interventions should be emphasized 9.
- The future direction of insomnia treatment should focus on non-pharmacologic interventions, treating comorbid conditions, and using benzodiazepines and non-benzodiazepine receptor agonists as last resorts 9.