From the Guidelines
For a 16-year-old female with insomnia and possible mood disorder, I would not recommend Seroquel (quetiapine) as a first-line treatment, due to its potential risks of metabolic effects, weight gain, and sedation, as highlighted in the study by 1. Instead, I recommend starting with sleep hygiene practices, as suggested by the American Academy of Sleep Medicine clinical practice guideline 1, which emphasizes the importance of establishing a consistent sleep schedule, removing electronics from the bedroom, avoiding caffeine after noon, and creating a relaxing bedtime routine. Additionally, melatonin can be considered as a treatment option, although the evidence for its use in adults is not strongly supported by the guideline 1, it may still be beneficial for adolescents. Melatonin can be started at 1-3 mg taken 1-2 hours before bedtime. If these interventions fail after 2-4 weeks, consider alternative treatment options, such as digital cognitive behavioral therapy for insomnia (CBT-I) apps or online programs, which have been shown to be effective in improving sleep quality, as discussed in the study by 1. It's also important to evaluate for underlying depression or anxiety that may be contributing to the sleep problems, as treating the mood disorder may resolve the insomnia. Some key points to consider when treating insomnia in adolescents include:
- Avoiding the use of benzodiazepines and trazodone due to their potential risks and limited benefits, as advised by the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1
- Encouraging sleep hygiene practices and considering melatonin as a treatment option
- Evaluating for underlying mood disorders and addressing them as part of the treatment plan
- Considering alternative treatment options, such as digital CBT-I, if initial interventions are unsuccessful.