Karsten Julie, Hagenauw Loes A, Kamphuis Jeanine, Lancel Marike
1 Department of Forensic Psychiatry, Mental Health Services Drenthe, Assen, the Netherlands.
2 Psychiatric Sleep Center Assen, Mental Health Services Drenthe, Assen, the Netherlands.
J Psychopharmacol. 2017 Mar;31(3):327-337. doi: 10.1177/0269881116681399. Epub 2017 Jan 16.
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.
低剂量的抗抑郁药米氮平或抗精神病药喹硫平常常被超适应症开处方用于治疗失眠。然而，关于其对睡眠的影响以及次日宿醉效应的研究却很稀少。在这项随机、双盲、交叉、安慰剂对照试验中，评估了7.5毫克米氮平和50毫克喹硫平对正常睡眠以及因声学应激（交通噪音）干扰的睡眠（作为短暂性失眠的模型）的影响。此外，还研究了次日警觉性和认知功能方面的宿醉效应。共有19名无睡眠问题的健康男性完成了三个治疗阶段，每个阶段在米氮平、喹硫平或安慰剂三种条件之一中连续进行三个夜晚。使用多导睡眠图和利兹睡眠评估问卷评估睡眠情况。使用利兹睡眠评估问卷、卡罗林斯卡嗜睡量表、数字符号替换任务、心理运动警觉任务和加法任务评估白天嗜睡情况和认知功能。在声学应激下，与安慰剂相比，米氮平和喹硫平均使总睡眠时间增加了半小时，觉醒次数减少了35 - 40%。虽然喹硫平特别增加了非快速眼动睡眠（N2期）的时长，但米氮平主要增加了深度睡眠（N3期）。受试者报告称，米氮平和喹硫平均使入睡更容易且改善了睡眠质量。两种药物都导致了白天嗜睡并降低了持续注意力。这些发现支持使用低剂量的米氮平和喹硫平治疗失眠。需要进一步对有效性和不良反应的长期影响进行前瞻性研究。
