Does Seroquel (quetiapine) help with insomnia?

From the Guidelines

Quetiapine (Seroquel) is not recommended as a first-line treatment for insomnia due to its potential side effects and lack of strong evidence supporting its efficacy for this purpose. According to the most recent and highest quality study 1, the evidence supporting the use of quetiapine for insomnia is sparse and unclear, with small sample sizes and short treatment durations. The study advises against the use of antipsychotics, including quetiapine, for the treatment of chronic insomnia disorder due to the potential harms associated with their use, such as increased risk for death in elderly populations with dementia-related psychosis and increased suicidal tendencies in children, adolescents, and young adults.

The American College of Physicians recommends cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for adults with chronic insomnia disorder 1. CBT-I has been shown to improve global outcomes, including increased remission and treatment response, and reduced insomnia severity index and Pittsburgh Sleep Quality Index scores compared with controls.

Some key points to consider when evaluating the use of quetiapine for insomnia include:

• The potential benefits of quetiapine for insomnia, such as improved sleep quality and duration, must be weighed against the potential risks, including morning drowsiness, dizziness, weight gain, and metabolic changes.
• Quetiapine is not FDA-approved for the treatment of insomnia, and its use for this purpose is considered off-label.
• Other treatment options, such as CBT-I, improving sleep hygiene, and medications specifically designed for sleep, may be more effective and safer for the treatment of insomnia.

In conclusion, while quetiapine may have some sedative effects, its use for insomnia is not supported by strong evidence, and it is not recommended as a first-line treatment due to its potential side effects and lack of efficacy. Instead, CBT-I and other evidence-based treatments should be considered as the primary approach for managing insomnia.

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 schizophrenia trials, somnolence was reported in 18% (89/510) of patients on quetiapine compared to 11% (22/206) of placebo patients In acute bipolar mania trials using quetiapine as monotherapy, somnolence was reported in 16% (34/209) of patients on quetiapine compared to 4% of placebo patients. In acute bipolar mania trials using quetiapine as adjunct therapy, somnolence was reported in 34% (66/196) of patients on quetiapine compared to 9% (19/203) of placebo patients In bipolar depression trials, somnolence was reported in 57% (398/698) of patients on quetiapine compared to 15% (51/347) of placebo patients

Seroquel (quetiapine) may help with sleeping due to its somnolent effects, which were commonly reported in patients treated with the medication, especially during the initial dose-titration period. The incidence of somnolence varied across different trials, ranging from 16% to 57% of patients on quetiapine, compared to 4% to 15% of placebo patients 2.

From the Research

Seroquel and Insomnia

• Seroquel (quetiapine) is increasingly being used off-label for treating insomnia in the general population, possibly to avoid standard medications with known addictive qualities and adverse side effects 3.
• However, evidence to support using it in this way is scant, and quetiapine is associated with weight gain and other metabolic effects 3.
• The safety and efficacy of quetiapine for the treatment of insomnia in adults are reviewed, and it is found that quetiapine's benefit in the treatment of insomnia has not been proven to outweigh potential risks, even in patients with a comorbid labeled indication for quetiapine 4.

Efficacy of Seroquel for Insomnia

• A systematic review and meta-analysis of clinical trials examining the efficacy of low-dose quetiapine in sleep found that quetiapine improved sleep quality compared with placebo 5.
• The pooled results showed that quetiapine increased total sleep time compared with placebo, but not when compared with other psychiatric drugs 5.
• Significant effects were observed in the general anxiety disorder, major depressive disorder, and healthy subgroups, at the dosage of 50 mg, 150 mg, and 300 mg 5.

Alternative Treatments for Insomnia

• Cognitive Behavioral Therapy for Insomnia (CBT-i) is now commonly recommended as first-line treatment for chronic insomnia, as it is likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches 6, 7.
• CBT-i is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes, and no adverse outcomes were reported 6.