Seroquel (Quetiapine) is an atypical antipsychotic medication developed and promoted by the company AstraZeneca. It is utilized for the treatment of serious psychiatric conditions, primarily schizophrenia. The “XR” (extended-release) version was among the top selling psychiatric drugs of 2013, and is clearly very profitable for both its developer as well as doctors that receive kickbacks for each prescription.
Estimated sales for Seroquel are over $1 billion, and steadily increasing. In addition to treating various types of schizophrenia, the drug is also commonly prescribed for bipolar disorder and as an augmentation strategy for major depression. In recent years, there has been a major uptick in the number of Seroquel prescriptions for insomnia.
Although Seroquel may be helpful for some cases of insomnia, there are considerable risks associated with using an antipsychotic rather than a standard hypnotic or even an antidepressant. Many doctors are quick to dole out Seroquel and should be questioned for such prescriptions due to the fact that Seroquel has not been formally approved by the FDA for treating insomnia. Furthermore, many patients taking Seroquel for their inability to sleep may be unaware of the potential risk – especially over the long-term.
Seroquel For Insomnia: A Risky Off-Label Treatment
Those taking Seroquel for insomnia are generally prescribed low doses to get the antihistamine effect. Low doses of the drug block both histamine receptors and Alpha-1 adrenergic receptors. The drug is unique in that when taken at moderate doses, Seroquel stimulates the adrenergic system and targets serotonin receptors. At higher doses, the drug inhibits dopamine receptors and elicits an antipsychotic effect.
While it has been argued that taking Seroquel at a low dose may be helpful to treat insomnia, there are various risks associated with long-term treatment. The drug affects the neurotransmission of dopamine, serotonin, and histamine – likely in many ways that still remain unknown. If you are currently taking Seroquel for insomnia or are considering it, beware of the potential risks and benefits.
Potential Benefits of Seroquel for Insomnia
Below is a list of potential benefits associated with using Seroquel for insomnia. Understand that these benefits are limited and do not apply to everyone.
- Cost: Generic versions of Seroquel (quetiapine) are available, meaning you can get it for relatively cheap, especially at a low dose. As the dosage increases, the pills tend to cost more, but for the most part, this medication is inexpensive. In some cases, the lower cost may be appealing or favorable to brand-name sleeping pills.
- Effective: When taken at low doses, the drug elicits an antihistamine effect, which results in drowsiness. This means when taken before bed, it can expedite the transition between wakefulness and sleep. The drug may make it easier to tone down stimulation due to stress or excess activation of the sympathetic nervous system. Although it isn’t an effective option for everyone, there are a significant number of anecdotal experiences highlighting its efficacy. It could be speculated that Seroquel works better for certain types of insomnia over others.
- Low dose: Any drug utilized for the treatment of insomnia should be taken at the minimal effective dose. Taking excess amounts of the drug may result in tolerance, and in the case of Seroquel, may elicit additional unwanted antipsychotic effects. The fact that only a low dose is required is a plus in that it may not create as many neurochemical changes, resulting in fewer side effects and an easier withdrawal.
- Sleep enhancement: In addition to helping people fall asleep or stay asleep throughout the night, Seroquel may actually bolster sleep quality. In other words, getting 8 hours of sleep with the drug may be more restful and restorative than a broken sleep or less deep sleep without the drug. The sleep enhancement potential of the drug is appealing to many who feel as if their sleep quality is suboptimal.
- Temporary: Most sources suggest that using Seroquel for insomnia should be temporary. Assuming patients and doctors adhere to its usage only for a short, temporary term, it should be fairly safe. Although it may be relatively risky in terms of side effect profile, a low dose on a temporary basis is considered justifiable by many doctors and psychiatrists when used for insomnia.
- Treat multiple conditions: Another appealing aspect of Seroquel is that it can be used to essentially “kill 2 birds with 1 stone.” Therefore if someone has schizophrenia, bipolar disorder, or depression with comorbid insomnia, it may be effective for both conditions. The ideal usage would be to treat schizophrenia with comorbid insomnia, but many have also found that it can work well for depression.
Potential Drawbacks of Seroquel for Insomnia
It is important to thoroughly understand the risks associated with using a potent antipsychotic drug, especially for a less serious psychiatric condition like insomnia. Although medication may be required for insomnia if natural interventions remain ineffective, standard hypnotics should be considered as a first-line treatment, whereas Seroquel should be a last-line option.
Better, proven treatments: Unless a person has a comorbid serious mental illness like schizophrenia, Seroquel shouldn’t be considered as a treatment for insomnia. There are considerably better, more proven options than using an antipsychotic to improve sleep. Examples of drugs that sleep experts would recommend include: Z-drugs (Ambien, Lunesta, Rozerem), antidepressants (e.g. Trazodone for insomnia), and benzodiazepines (Xanax, Ativan, Klonopin).
If a person has gone through the ringer of sleeping pills, and they are all found ineffective, only then should a drug like Seroquel be considered. While benzodiazepines are linked to dementia, various antidepressants are considered safer options than antipsychotics. Additionally, none of these drugs are meant to be taken over the long-term.
Brain volume loss: There is notable evidence that taking antipsychotics can lead to loss of brain volume. This means that not only could you be killing brain cells by using Seroquel for insomnia. Research in both animals and humans has established that antipsychotic usage is associated with reduced volume of both grey matter and white matter.
Dependence: While makers of the drug and psychiatrists may not admit it, many people become dependent upon Seroquel for functioning. If you’re taking it for insomnia, you may depend on it as a means to fall asleep. In other words, people like the fact that the drug is working so well, that they never attempt any natural remedies for insomnia such as deep breathing, relaxation techniques, meditation, or avoiding caffeine. Should they ever stop incorporating the drug in their routine, they may feel as if they cannot function.
Drowsiness: The drowsiness experienced from the drug may be helpful when it comes to falling asleep, but may impair your ability to function the next day. You may find that you experience overwhelming brain fog or can’t think as well throughout your workday. Additionally, you could be hazard to others if you chose to drive (or operate heavy machinery) while in this state of drowsiness.
Lack of evidence: There is little evidence to suggest that low dose Seroquel is an effective treatment for insomnia. Despite the drug’s perception of being an effective treatment for insomnia, there is minimal evidence in support of these claims. Most studies analyzing its ability to treat insomnia were short-term and contained small sample sizes.
Long-term effects: It has been advised that Seroquel shouldn’t be used for longer than 30 days (even at a low dose) for the specific purpose of treating insomnia. Using Seroquel even for a moderate term may result in some sort of dependence and/or neurochemical alterations that may result in a difficult withdrawal. Long-term usage is associated with increasing dosages as a result of tolerance and ultimately more potent side effects (e.g. brain volume loss).
Lethargy: In addition to feeling drowsy and experiencing significant brain fog, you may become lethargic. It may be difficult to take care of yourself, get out of bed in the morning, or even think about exercise. This lethargy can accumulate over time, transforming someone who was previously active into a major couch potato.
Safety concerns: Research suggests that despite Seroquel’s anecdotal efficacy for treating insomnia, there are numerous safety concerns. These safety concerns are largely a result of reported adverse reactions (even at a low dose) including: liver damage, restless leg syndrome, and akathisia. Many times these safety concerns aren’t discussed between patient and doctor, leaving the patient to remain unaware.
Side effects: Due to the fact that this is a potent antipsychotic, you’re likely going to experience some side effects, even when taken at a low dose. The side effects could include: dry mouth, dizziness, sore throat, and stomach pain. It is important to fully understand the drug’s side effect profile before using it to treat insomnia; the side effects may outweigh the benefit.
Weight gain: Want to experience rapid weight gain? Try taking Seroquel. There is significant evidence linking Seroquel and weight gain. Although taking a low dose for insomnia won’t result in as much extra “baggage” as taking high doses for schizophrenia, it may ramp up your cravings for food – especially at night. If you find yourself raiding the fridge more often, it’s probably the medication.
Withdrawal: Taking low doses of the drug for the purpose of treating insomnia can still result in discontinuation effects. The Seroquel withdrawal symptoms are often considered difficult to cope with, and include both nausea and insomnia. The irony is that your insomnia during withdrawal may be even worse than prior to your first dose of the drug.
This is due to the fact that your brain had become reliant on the drug and no longer manufactured endogenous hormones and neurotransmitters to facilitate sleep. Although low dose withdrawal may not be as bad as higher dose withdrawal, if you were taking the drug for a long-term, the withdrawal period may last longer than you’d expect (e.g. weeks or months).
- Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476840/
Does the evidence justify using Seroquel for insomnia?
Seroquel has been studied for the treatment of insomnia in very few studies. There are a couple randomized, controlled trials that investigated Seroquel’s ability to treat insomnia among individuals void of psychiatric or medical conditions. The 2004 study analyzed how people without insomnia would respond to Seroquel in terms of sleep.
This study consisted of 14 participants (all males) with a double-blind, randomized, placebo-controlled set-up. Either a placebo or Seroquel (at 25 mg or 100 mg) were given on 3 consecutive nights to determine how participants would respond. Sleep-related questionnaires were administered the following morning. Sleep time, efficiency, and latency were all documented by researchers.
Those taking the 100 mg dose experienced leg movements and reduced REM stage sleep. Researchers vaguely concluded that Seroquel may improve sleep and/or modify sleep structure. The 2010 study analyzed how 25 individuals with primary insomnia would respond to Seroquel as a treatment.
Results from the study revealed that those taking 25 mg of Seroquel increased their TST (total sleep time) and reduced their SL (sleep latency). In other words, people slept longer and fell asleep quicker when they took Seroquel. However, these changes in total sleep time and sleep latency times were not statistically significant.
Though there is some evidence to suggest that Seroquel may improve the sleep of some individuals, there is minimal research supporting this idea. Some doctors resort to prescribing the drug simply to avoid reaching limits for prescriptions of sedative agents and/or as a sneaky way to bypass Medicaid managed care plan authorization requirements. Not only is there no substantial evidence to support the use of Seroquel for insomnia, it is a risky option in regards to side effects and adverse reactions.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/15029469
- Source: http://www.ncbi.nlm.nih.gov/pubmed/20572379
- Source: http://www.ncbi.nlm.nih.gov/pubmed/22510671
- Source: http://www.orpdl.org/durm/drug_articles/evaluations/seroquel_due.pdf
Risk-Benefit Ratio of Seroquel for Insomnia
If you plan on using Seroquel to treat your insomnia, it is important to analyze the potential risks and benefits. You should constantly be weighing the pros and cons associated with your treatment. If the drug is working well to treat your insomnia, carries few side effects, and you don’t plan on using it for a long-term – its usage may be justified.
In the event that the drug isn’t working very well for your insomnia, you’ve failed to explore standard hypnotics, and you’re experiencing side effects – it may be advisable to discontinue Seroquel and transition to a more evidence-based hypnotic. It is important to keep in mind that each person taking Seroquel for insomnia may have a different set of risks and benefits.
Some individuals report that Seroquel is the only drug that provides lasting insomnia relief, while others have found that Seroquel does nothing to reduce insomnia or enhance sleep quality. Additionally, this drug should not be considered a long-term solution as associated risks will greatly increase (e.g. adverse reactions).
Should you take Seroquel for insomnia?
While Seroquel may be a profitable medication for AstraZeneca and doctors to prescribe, it’s not officially approved for the treatment of insomnia. Therefore all other options should be exhausted before resorting to the potent antipsychotic that is Seroquel. Assuming you’ve given natural remedies for insomnia a try such as: daily exercise in the morning, meditation, emWave2, you may need a medication.
However even before a medication, you may want to investigate the therapeutic potential of supplements including: melatonin, valerian root, or L-Tryptophan. Only after you’ve tested the natural options should you think about medications. Visiting a sleep expert may help you get a better idea as to what’s causing your insomnia, and get a better idea of the most effective pharmaceutical sleeping pills.
Since nonbenzodiazepine sleeping pills have proven themselves as an effective first-line treatment, those should be tested prior to others. Should those be ineffective, a doctor may test certain antidepressants, which are considered safer than Seroquel. If you’re unresponsive to all treatment modalities, extremely low dose Seroquel may be an effective option.
Seroquel vs. Z-Drugs
A majority of people will respond very well to Z-drugs (nonbenzodiazepines) as a means to fall asleep. Z-drugs have proven themselves as effective agents in large-scale studies, and are considered relatively safe when used properly as a short-term intervention. The Z-drugs are medications that are specifically engineered with the purpose of reducing sleep latency and improving sleep quality.
Seroquel was designed to target various symptoms of schizophrenia, making it more likely to disrupt your neurotransmission. A majority of sleep experts would not recommend using Seroquel when there are clearly more effective and safer options on the market. Unless you’ve already explored the potential of the FDA approved sleep aids, you shouldn’t be in any hurry to try Seroquel for insomnia.
Ideal: Seroquel for Schizophrenia with comorbid Insomnia
The ideal scenario for using Seroquel as a treatment for insomnia is among those with a serious psychiatric condition like schizophrenia or bipolar disorder. Seroquel is considered an approved treatment for those conditions. Should an individual find that the drug works well for their schizophrenia, they may get the added benefit of improved sleep.
It is important to also consider the fact that the drug may work well for the approved condition (schizophrenia) and poorly for the off-label condition (insomnia). In cases where a person suffers from depression and insomnia, a psychiatrist may consider testing low dose Seroquel to determine whether the drug simultaneously improves the patient’s mood and sleep quality. In some cases the drug may be ineffective for both conditions; this is also something to consider.
Have you taken Seroquel for insomnia?
If you’ve taken Seroquel for insomnia, feel free to share whether you have any other conditions or solely insomnia. To help others better understand your situation, explain whether you are on a low dose, moderate dose, or high dose – and whether you’ve had to increase the dose over time. Share how long you’ve been taking the drug for insomnia and whether you’ve experienced any unwanted side effects.