Avoid Antipsychotics As First-Line Insomnia Therapy, Groups Say

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Although antipsychotics are often prescribed by psychiatrists to treat insomnia, a group of Canadian psychiatric organizations is recommending against the practice due to the side effects associated with the drugs.

The recommendations were made by a working group comprised of the Canadian Psychiatric Association (CPA), the Canadian Academy of Child and Adolescent Psychiatry (CACAP), and the Canadian Academy of Geriatric Psychiatry (CAGP) for the Choosing Wisely Canada (CWC) campaign.

One of the reasons that the group disapproves of antipsychotic use to promote sleep is the the drug class is associated with weight again and metabolic disorders, Chris Wilkes, MD, head of Child and Adolescent Outpatient and Specialized Services in the Department of Psychiatry, University of Calgary, Alberta, and president of CACAP, told Medscape Medical News.

He added that while a pharmacological intervention may be beneficial in the short term, long-term use could create medical issues.

In lieu of medication, Choosing Wisely Canada recommends an evaluation to determine if behavioral causes, such as poor sleep schedule or caffeine intake, emotional causes, such as stress, or psychiatric or physical causes, such as pain or sleep apnea, are at the root of the insomnia. They add that nonpharmacologic intervention, including teaching patients about proper sleep hygiene and behavioral modifications, should be tried first, as well as the herbal remedy melatonin.

However, if a medication is needed, one approved for insomnia should be used at the lowest possible dose for the shortest period of time, in addition to nonpharmacological techniques, Wilkes said.

Choosing Wisely Canada also offers other recommendations for psychiatrists that tend to focus on limiting the use of psychiatric drugs as a first-line treatment for many mental illnesses.

Sleep "Debt" Seen in Adults with Stress, Poor Health
Side effects of antipsychotics are a concern when used for insomnia.

Antipsychotics should not be routinely used to treat primary insomnia in children, adults, or the elderly, according to new recommendations issued by leading Canadian psychiatric organizations.

This and 12 other evidence-based recommendations were released by a joint working group of the Canadian Psychiatric Association (CPA), the Canadian Academy of Child and Adolescent Psychiatry (CACAP), and the Canadian Academy of Geriatric Psychiatry (CAGP) for the Choosing Wisely Canada (CWC) campaign.

Instead, the CWC psychiatry working group recommends thorough assessment to establish possible behavioral causes (eg, poor sleep-wake schedule, use of caffeine and nicotine), emotional causes (eg, stress), and psychiatric or physical causes (eg, pain, sleep apnea) of insomnia.

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