title: A case of dose escalation of quetiapine in persistent insomnia disorder.
abstract: Quetiapine, an atypical antipsychotic drug, is recommended for the treatment of schizophrenia and mood disorders. In addition, given its sedative effects, a low dose of the agent is also widely used in the treatment of anxiety disorders, personality disorders, substance abuse, and sleep disturbances. In this case study, quetiapine was the first effective drug in reducing chronic insomnia in a male patient with a long treatment history. Because its effect declined over time, in the course of two years, a gradual dose increase led to a posology 50 times higher than the off-label dosage used to obtain sedation, i.e. 25-100 mg quetiapine administered once daily. This case raises awareness of the ease with which dose escalation of quetiapine occurs. The risk of side effects and, possibly, dependence and abuse underlines the importance of regular and careful patient monitoring. Given the unexpected effectiveness of the agent and the absence of side effects in the described case, we argue that in treatment-resistant insomnia, a high dose of quetiapine may be justifiable in selected cases but also urge that further research on the long-term effects and potential adverse events of quetiapine for this indication is of the utmost importance.
authors.affiliation: a Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute , University of Antwerp , Antwerp , Belgium.|b University Department of Psychiatry , Campus Psychiatric Hospital, Duffel , Belgium.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cornelis
authors.affiliation: a Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute , University of Antwerp , Antwerp , Belgium.|c University Department of Psychiatry , Campus Antwerp University Hospital, Edegem , Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Van Gastel
authors.affiliation: d Department of Clinical Pharmacology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.
authors.forename: Glenn
authors.initials: G
authors.lastname: Dumont
authors.affiliation: a Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute , University of Antwerp , Antwerp , Belgium.|b University Department of Psychiatry , Campus Psychiatric Hospital, Duffel , Belgium.
authors.forename: Violette
authors.initials: V
authors.lastname: Coppens
authors.affiliation: a Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute , University of Antwerp , Antwerp , Belgium.|b University Department of Psychiatry , Campus Psychiatric Hospital, Duffel , Belgium.|c University Department of Psychiatry , Campus Antwerp University Hospital, Edegem , Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Sabbe
authors.affiliation: a Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute , University of Antwerp , Antwerp , Belgium.|b University Department of Psychiatry , Campus Psychiatric Hospital, Duffel , Belgium.
authors.forename: Manuel
authors.initials: M
authors.lastname: Morrens
authors.affiliation: a Department of Adult Psychiatry, Collaborative Antwerp Psychiatric Research Institute , University of Antwerp , Antwerp , Belgium.|c University Department of Psychiatry , Campus Antwerp University Hospital, Edegem , Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Van Den Eede
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D000069348:Quetiapine Fumarate / Q000008:administration & dosage*; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D000069348:Quetiapine Fumarate
keywords: Fatigue; Insomnia disorder; Quetiapine; Sedation; Tolerance