Is Seroquel (quetiapine) effective for treating insomnia?

From the Guidelines

Quetiapine (Seroquel) is not recommended as a first-line treatment for insomnia due to its potential risks and side effects, and the availability of safer, more effective treatments. The most recent and highest quality study, 1, suggests that the goal of treatment for insomnia is to improve sleep and alleviate distress or dysfunction caused by the disorder, and that psychological therapy options, such as cognitive behavioral therapy for insomnia (CBT-I), and pharmacologic therapy, including medications specifically approved for insomnia, are preferred.

Some key points to consider when treating insomnia include:

• Non-medication approaches, such as sleep hygiene improvements and CBT-I, should be considered first-line treatments for insomnia
• If medication is needed, consider short-term use of medications specifically approved for insomnia, such as zolpidem (Ambien), eszopiclone (Lunesta), or low-dose doxepin
• Quetiapine carries risks, including metabolic effects, movement disorders, and cardiac effects, that make its risk-benefit profile unfavorable for simple insomnia
• The sedating effect of quetiapine occurs because it blocks histamine receptors in the brain, but this comes with the baggage of its other effects on dopamine and serotonin receptors that aren't needed for sleep

As noted in 1 and 1, pharmacologic therapy in the United States includes drugs approved by the U.S. Food and Drug Administration (FDA) for insomnia treatment, and quetiapine is not a first-line treatment option. Instead, it is recommended to use evidence-based treatments, such as those outlined in 1, which provides a clinical guideline for the evaluation and management of chronic insomnia in adults.

In terms of specific treatment options, the following are recommended:

• Cognitive behavioral therapy for insomnia (CBT-I)
• Multicomponent behavioral therapy or brief behavioral therapy (BBT) for insomnia
• Medications specifically approved for insomnia, such as zolpidem (Ambien), eszopiclone (Lunesta), or low-dose doxepin
• Other interventions, such as stimulus control, relaxation strategies, and sleep restriction, as outlined in 1 and 1.

From the Research

Effectiveness of Seroquel for Insomnia

• Seroquel (quetiapine) is sometimes used off-label to treat insomnia, but the evidence to support its use for this purpose is limited 2.
• There is no clear indication that Seroquel is effective for treating primary insomnia, and its use may be associated with significant risks, such as weight gain and metabolic effects 2.
• Cognitive-behavioral therapy for insomnia (CBT-i) is a highly effective treatment for chronic insomnia, with no side effects and long-term improvements in sleep quality 3, 4, 5.
• CBT-i is recommended as a first-line treatment for chronic insomnia, but it is often underutilized due to a shortage of trained practitioners and lack of patient awareness 3, 4.

Alternative Treatments for Insomnia

• Sedating antidepressants, such as mirtazapine and tricyclic antidepressants, may be used to treat insomnia, particularly when it is comorbid with depression or anxiety disorders 6.
• Behavioral therapies, such as multicomponent cognitive-behavioral therapy, and lifestyle changes can also be effective in treating chronic insomnia 6.
• Melatonin and melatonin-receptor agonists, such as ramelteon, may be used to treat insomnia, but more research is needed to define their use in psychiatric patients 6.

Risks and Considerations

• The use of Seroquel for insomnia should be approached with caution, as it is associated with significant risks and side effects, including weight gain and metabolic effects 2.
• Patients should be monitored closely for adverse effects and abuse when using Seroquel off-label for insomnia 2.
• Clinicians should consider recommending CBT-i as a first-line treatment for chronic insomnia, due to its high efficacy and lack of side effects 3, 4, 5.