Effects of quetiapine on sleep architecture in patients with unipolar or bipolar depression

Abstract

Objective:To determine the effect of adjunctive quetiapine therapy on the sleep architecture of patients with bipolar or unipolar depression. Methods: This is a prospective, single-blind, repeated measures polysomnographic study. Sleep architecture was analyzed by overnight polysomnography, and subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. The Hamilton Rating Scale for Depression, Montgomery Asberg Depression Rating Scale, Young Mania Rating Scale, and Clinical Global Impression-Severity Scale were employed to quantify changes in illness severity with adjunctive quetiapine treatment. Polysomnographs and clinical measures were administered at baseline, after 2-4 days of treatment, and after 21-28 days of quetiapine treatment. The average dose of quetiapine was 155 mg, ranging from 100-200 mg. Results: Adjunctive quetiapine therapy did not significantly alter sleep efficiency, sleep continuity, or Pittsburgh Sleep Quality Index scores. Respiratory Disturbance Index and percentage of total time in rapid eye movement (REM) sleep significantly decreased and the percentage of total time in non-REM sleep, and duration of Stage 2 and non-REM sleep significantly increased after 2-4 days of quetiapine treatment. Illness severity significantly decreased over time. Conclusions: Adjunctive quetiapine treatment alters sleep architecture in patients with major depressive disorder or bipolar disorder, which may partially explain its early antidepressant properties. Changes in sleep architecture are more robust and significant within two to four days of starting treatment.

Sleep architecture and cognitive changes in olanzapine-treated patients with depression: A double blind randomized placebo controlled trial

“…Antidepressants rarely improve sleep continuity; most improvements are seen with tricyclic antidepressants. Increased total sleep time and sleep efficiency, as well as decreased sleep latency and total wake time were observed here, similar to that seen with other augmentation agents such as risperidone [ 64 ], but different than quetiapine, which does not alter sleep continuity in depression [ 65 ]. The beneficial effects of olanzapine treatment on sleep continuity may be due to its diverse pharmacological profile.…”

“…Although previous studies of augmentation to SSRIs have shown R suppression, the degree of polypharmacy was less in these studies, as each participant was only taking one antidepressant [ 70 ]. This may reflect the changes often seen with psychotropic treatment to sleep architecture [ 65 , 71 ]. Few medications have been reliably shown to suppress R sleep and also increase sleep continuity and SWS.…”

Effects of the antipsychotic quetiapine on sleep and breathing: a review of clinical findings and potential mechanisms

“…Another non-RCT noted there was no significant change in respiratory disturbance index between baseline and quetiapine. Unfortunately, however, neither data nor statistical inference were provided (Gedge et al, 2010). an individual has OSA continues to evolve with early definitions defining OSA as ≥5 respiratory events/h of sleep (Kapur et al, 2017).…”

Quetiapine monotherapy versus placebo in the treatment of children and adolescents with bipolar depression: a systematic review and meta-analysis

“… 12 A previous study suggests that an adjunctive quetiapine treatment can alter the sleep architecture in patients with MDD or bipolar depression. 13 In addition, it also has an active metabolite, norquetiapine ( N -desalkyl quetiapine), which has a high affinity for norepinephrine transporters and partially agonizes to serotonin 5-HT 1A receptors. 14 Hence, the efficacy of quetiapine in ameliorating depressive symptoms in adults with unipolar and bipolar depression may be associated with antagonizing at 5-HT 2A , α 2b adrenergic, and D 2 receptors and agonizing at a 5-HT 1A receptor and its effect on sleep architecture.…”

“… 14 Hence, the efficacy of quetiapine in ameliorating depressive symptoms in adults with unipolar and bipolar depression may be associated with antagonizing at 5-HT 2A , α 2b adrenergic, and D 2 receptors and agonizing at a 5-HT 1A receptor and its effect on sleep architecture. 13 , 15…”