title: Low doses of mirtazapine or quetiapine for transient insomnia: A randomised, double-blind, cross-over, placebo-controlled trial.
abstract: Low doses of the antidepressant mirtazapine or the neuroleptic quetiapine are often prescribed off-label for insomnia. However, studies on the effects on sleep and hangover effects the following day are scarce. In this randomised, double-blind, cross-over, placebo-controlled trial, the influence of 7.5 mg mirtazapine and 50 mg quetiapine on both normal sleep and sleep disturbed by acoustic stress (traffic noise) as a model for transient insomnia was assessed. Additionally, hangover effects on next-day alertness and cognitive functioning were examined. A total of 19 healthy men without sleep complaints completed three treatment sessions, each session consisting of three consecutive nights in one of the mirtazapine, quetiapine or placebo conditions. Sleep was assessed using polysomnography and the Leeds Sleep Evaluation Questionnaire. Daytime sleepiness and cognitive functioning were assessed using the Leeds Sleep Evaluation Questionnaire, Karolinska Sleepiness Scale, Digit Symbol Substitution Task, Psychomotor Vigilance Task and an addition task. Under acoustic stress, both mirtazapine and quetiapine increased total sleep time by half an hour and reduced the number of awakenings by 35-40% compared to placebo. While quetiapine specifically increased the duration of non-rapid eye movement sleep, stage N2, mirtazapine mainly increased deep sleep stage N3. Subjects reported that both mirtazapine and quetiapine eased getting to sleep and improved sleep quality. Both drugs caused daytime sleepiness and lessened sustained attention. These findings support the use of low doses of mirtazapine and quetiapine for the treatment of insomnia. Further prospective studies on the long-term effects regarding effectiveness and adverse effects are needed.
authors.affiliation: 1 Department of Forensic Psychiatry, Mental Health Services Drenthe, Assen, the Netherlands.
authors.forename: Julie
authors.initials: J
authors.lastname: Karsten
authors.affiliation: 1 Department of Forensic Psychiatry, Mental Health Services Drenthe, Assen, the Netherlands.
authors.forename: Loes A
authors.initials: LA
authors.lastname: Hagenauw
authors.affiliation: 1 Department of Forensic Psychiatry, Mental Health Services Drenthe, Assen, the Netherlands.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Kamphuis
authors.affiliation: 1 Department of Forensic Psychiatry, Mental Health Services Drenthe, Assen, the Netherlands.|2 Psychiatric Sleep Center Assen, Mental Health Services Drenthe, Assen, the Netherlands.|3 Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Marike
authors.initials: M
authors.lastname: Lancel
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001288:Attention / Q000187:drug effects; D003071:Cognition / Q000187:drug effects; D018592:Cross-Over Studies; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078785:Mirtazapine; D000069348:Quetiapine Fumarate / Q000627:therapeutic use*; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D012894:Sleep Stages / Q000187:drug effects; D014851:Wakefulness / Q000187:drug effects; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D008803:Mianserin; D000069348:Quetiapine Fumarate; D000078785:Mirtazapine
keywords: Mirtazapine; daytime functioning; insomnia; quetiapine; sleep; traffic noise