From the Guidelines
Seroquel (quetiapine) should not be used as a first-line treatment for sleep in bipolar disorder due to its potential harms and lack of clear efficacy for insomnia. The 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines advise against the use of antipsychotics, including quetiapine, for the treatment of chronic insomnia disorder 1. This recommendation is based on the sparse and unclear evidence supporting the use of antipsychotics for insomnia, as well as the known harms associated with their use, including increased risk for death in elderly populations with dementia-related psychosis and increased suicidal tendencies in children, adolescents, and young adults 1.
Instead, nonpharmacologic behavioral interventions, such as cognitive-behavioral therapy for insomnia (CBT-I), are recommended as the first-line treatment for chronic insomnia disorder due to their superior long-term outcomes and fewer adverse effects compared to pharmacotherapy 1. If pharmacotherapy is necessary, a short course of low-dose doxepin or nonbenzodiazepine benzodiazepine receptor agonists (BZRAs) may be considered for appropriate candidates 1.
It is essential to weigh the potential benefits and harms of any treatment for sleep in bipolar disorder and to prioritize nonpharmacologic interventions whenever possible. Regular follow-up with a psychiatrist is crucial to monitor for side effects and adjust treatment plans as needed. Key considerations for treatment include:
- The potential harms associated with antipsychotic use, including increased risk for death and suicidal tendencies
- The lack of clear efficacy for antipsychotics in treating insomnia
- The superior long-term outcomes and fewer adverse effects of nonpharmacologic behavioral interventions, such as CBT-I
- The importance of regular follow-up and monitoring for side effects and treatment efficacy.
From the Research
Seroquel for Sleep in Bipolar Disorder
- Seroquel, also known as quetiapine, is an atypical antipsychotic that is indicated for the treatment of schizophrenia and bipolar disorder, including bipolar depression 2.
- The medication has been shown to be effective in improving depressive symptoms in patients with bipolar disorder, and it is also used off-label for the treatment of insomnia and other sleep disturbances 2.
- However, the use of Seroquel for sleep in bipolar disorder is not explicitly mentioned in the provided studies, but its sedative effects are noted as a common adverse event 2.
- Sleep disturbances are a common feature of bipolar disorder, and they can have a significant impact on the course of the illness, including triggering manic or depressive episodes 3, 4, 5, 6.
- The treatment of sleep disturbances in bipolar disorder may involve a range of strategies, including medication, cognitive-behavioral therapy, and light therapy 3, 4, 5, 6.
- Quetiapine's mechanism of action, which includes antagonism of serotonin 5-HT2 and dopamine D2 receptors, may also contribute to its sedative effects and potential benefits for sleep disturbances in bipolar disorder 2.