Editing Insomnia (section)

==== Antipsychotics ====
Certain [[atypical antipsychotic]]s, particularly [[quetiapine]], [[olanzapine]], and [[risperidone]], are used in the treatment of insomnia.<ref name="pmid27544830">{{cite journal | vauthors = Thompson W, Quay TA, Rojas-Fernandez C, Farrell B, Bjerre LM | title = Atypical antipsychotics for insomnia: a systematic review | journal = Sleep Med | volume = 22 | issue = | pages = 13–17 | date = June 2016 | pmid = 27544830 | doi = 10.1016/j.sleep.2016.04.003 | url = }}</ref><ref name="Morin2014">{{cite journal | vauthors = Morin AK | title = Off-label use of atypical antipsychotic agents for treatment of insomnia | journal = Mental Health Clinician | date = 1 March 2014 | volume = 4 | issue = 2 | pages = 65–72 | eissn = 2168-9709 | doi = 10.9740/mhc.n190091 | pmid = | url = | doi-access = free }}</ref> However, while common, the use of antipsychotics for this indication is not recommended as the evidence does not demonstrate a benefit, and the risk of adverse effects is significant.<ref name="pmid27544830" /><ref>{{Citation |author1=American Psychiatric Association |author1-link=American Psychiatric Association |date=September 2013 |title=Five Things Physicians and Patients Should Question |publisher=[[American Psychiatric Association]] |work=[[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url=http://www.choosingwisely.org/doctor-patient-lists/american-psychiatric-association/ |access-date=30 December 2013 |url-status=live |archive-url=https://web.archive.org/web/20131203174206/http://www.choosingwisely.org/doctor-patient-lists/american-psychiatric-association/ |archive-date=3 December 2013 }}, which cites
* {{cite journal | title = Consensus development conference on antipsychotic drugs and obesity and diabetes | journal = Diabetes Care | volume = 27 | issue = 2 | pages = 596–601 | date = February 2004 | pmid = 14747245 | doi = 10.2337/diacare.27.2.596 | author1 = American Association of Clinical Endocrinologists | author2 = North American Association for the Study of Obesity | doi-access = free }}
* {{cite book | vauthors = Maglione M, Maher AR, Hu J, Wang Z, Shanman R, Shekelle PG, Roth B, Hilton L, Suttorp MJ, Ewing BA, Motala A, Perry T | chapter = Off-Label Use of Atypical Antipsychotics: An Update | title = AHRQ Comparative Effectiveness Reviews | location = Rockville (MD) | publisher = Agency for Healthcare Research and Quality (US)| date = Sep 2011 | pmid = 22132426 }}
* {{cite journal | vauthors = Nasrallah HA | title = Atypical antipsychotic-induced metabolic side effects: insights from receptor-binding profiles | journal = Molecular Psychiatry | volume = 13 | issue = 1 | pages = 27–35 | date = January 2008 | pmid = 17848919 | doi = 10.1038/sj.mp.4002066 | s2cid = 205678886 }}</ref><ref>{{cite journal | vauthors = Coe HV, Hong IS | title = Safety of low doses of quetiapine when used for insomnia | journal = The Annals of Pharmacotherapy | volume = 46 | issue = 5 | pages = 718–722 | date = May 2012 | pmid = 22510671 | doi = 10.1345/aph.1Q697 | s2cid = 9888209 }}</ref><ref name="Off-Label Use">{{cite book |title=Off-Label Use of Atypical Antipsychotics: An Update |vauthors=Maglione M, Maher AR, Hu J, Wang Z, Shanman R, Shekelle PG, Roth B, Hilton L, Suttorp MJ |publisher=Agency for Healthcare Research and Quality |year=2011 |series=Comparative Effectiveness Reviews, No. 43 |location=Rockville |pmid=22973576}}</ref> A major 2022 systematic review and network meta-analysis of medications for insomnia in adults found that quetiapine did not demonstrate any short-term benefits for insomnia.<ref name="pmid35843245">{{cite journal |vauthors=De Crescenzo F, D'Alò GL, Ostinelli EG, Ciabattini M, Di Franco V, Watanabe N, Kurtulmus A, Tomlinson A, Mitrova Z, Foti F, Del Giovane C, Quested DJ, Cowen PJ, Barbui C, Amato L, Efthimiou O, Cipriani A |date=July 2022 |title=Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis |url= |journal=Lancet |volume=400 |issue=10347 |pages=170–184 |doi=10.1016/S0140-6736(22)00878-9 |pmid=35843245 |s2cid=250536370|doi-access=free |hdl=11380/1288245 |hdl-access=free }}</ref> Some of the more serious adverse effects may also occur at the low doses used, such as [[dyslipidemia]] and [[neutropenia]].<ref>{{cite journal | vauthors = Pillinger T, McCutcheon RA, Vano L, Mizuno Y, Arumuham A, Hindley G, Beck K, Natesan S, Efthimiou O, Cipriani A, Howes OD | title = Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis | journal = The Lancet. Psychiatry | volume = 7 | issue = 1 | pages = 64–77 | date = January 2020 | pmid = 31860457 | pmc = 7029416 | doi = 10.1016/s2215-0366(19)30416-x }}</ref><ref>{{cite journal | vauthors = Yoshida K, Takeuchi H | title = Dose-dependent effects of antipsychotics on efficacy and adverse effects in schizophrenia | journal = Behavioural Brain Research | volume = 402 | pages = 113098 | date = March 2021 | pmid = 33417992 | doi = 10.1016/j.bbr.2020.113098 | s2cid = 230507941 | doi-access = free }}</ref> Such concerns of risks at low doses are supported by Danish observational studies that showed an association of use of low-dose quetiapine (excluding prescriptions filled for tablet strengths >50&nbsp;mg) with an increased risk of major cardiovascular events as compared to use of [[Z-drugs]], with most of the risk being driven by cardiovascular death.<ref>{{cite journal | vauthors = Højlund M, Andersen K, Ernst MT, Correll CU, Hallas J | title = Use of low-dose quetiapine increases the risk of major adverse cardiovascular events: results from a nationwide active comparator-controlled cohort study | journal = World Psychiatry | volume = 21 | issue = 3 | pages = 444–451 | date = October 2022 | pmid = 36073694 | pmc = 9453914 | doi = 10.1002/wps.21010 }}</ref> Laboratory data from an unpublished analysis of the same cohort also support the lack of dose-dependency of metabolic side effects, as new use of low-dose quetiapine was associated with a risk of increased fasting triglycerides at one-year follow-up.<ref>{{Cite thesis |date=2022-09-12 |title=Low-dose Quetiapine: Utilization and Cardiometabolic Risk |url=https://portal.findresearcher.sdu.dk/en/publications/low-dose-quetiapine-utilization-and-cardiometabolic-risk |language=English |doi=10.21996/mr3m-1783 |vauthors=Højlund M |publisher=Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet |access-date=2022-10-18 |archive-date=2022-10-18 |archive-url=https://web.archive.org/web/20221018082542/https://portal.findresearcher.sdu.dk/en/publications/low-dose-quetiapine-utilization-and-cardiometabolic-risk |url-status=live }}</ref> Concerns regarding side effects are greater in the elderly.<ref name="Conn 271–287">{{cite journal |vauthors=Conn DK, Madan R |year=2006 |title=Use of sleep-promoting medications in nursing home residents: risks versus benefits |journal=Drugs & Aging |volume=23 |issue=4 |pages=271–87 |doi=10.2165/00002512-200623040-00001 |pmid=16732687 |s2cid=38394552}}</ref>