Effects of quetiapine on sleep architecture in patients with unipolar or bipolar depression

Abstract

Objective: To determine the effect of adjunctive quetiapine therapy on the sleep architecture of patients with bipolar or unipolar depression.

Methods: This is a prospective, single-blind, repeated measures polysomnographic study. Sleep architecture was analyzed by overnight polysomnography, and subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. The Hamilton Rating Scale for Depression, Montgomery Asberg Depression Rating Scale, Young Mania Rating Scale, and Clinical Global Impression-Severity Scale were employed to quantify changes in illness severity with adjunctive quetiapine treatment. Polysomnographs and clinical measures were administered at baseline, after 2-4 days of treatment, and after 21-28 days of quetiapine treatment. The average dose of quetiapine was 155 mg, ranging from 100-200 mg.

Results: Adjunctive quetiapine therapy did not significantly alter sleep efficiency, sleep continuity, or Pittsburgh Sleep Quality Index scores. Respiratory Disturbance Index and percentage of total time in rapid eye movement (REM) sleep significantly decreased and the percentage of total time in non-REM sleep, and duration of Stage 2 and non-REM sleep significantly increased after 2-4 days of quetiapine treatment. Illness severity significantly decreased over time.

Conclusions: Adjunctive quetiapine treatment alters sleep architecture in patients with major depressive disorder or bipolar disorder, which may partially explain its early antidepressant properties. Changes in sleep architecture are more robust and significant within two to four days of starting treatment.

Keywords: bipolar disorder; depression; quetiapine; sleep architecture.

Figure 1

Mean ± standard error of sleep efficiency (percentage) over one month of adjunctive quetiapine treatment in 11 subjects. Sleep was assessed by polysomnography at baseline, and after 2–4 days and 21–28 days following initiation of quetiapine treatment. There was no significant difference in sleep efficiency after 2–4 days or one month of quetiapine treatment.

Figure 2

Mean ± standard error of the MADRS score over one month of adjunctive quetiapine treatment in 11 subjects. MADRS score was assessed at baseline, after acute treatment (2–4 days), and after longer-term treatment (21–28 days) with quetiapine. After 2–4 days and 21–28 days of quetiapine treatment, MADRS scores significantly decreased from baseline measurements (P = 0.01 and P = 0.008, respectively). *P < 0.05 compared with baseline. Abbreviation: MADRS, Montgomery Asperg Depression Rating Scale.

Figure 3

Mean ± standard error of the HDRS score over one month of quetiapine adjunctive treatment in 11 subjects. HDRS-17 score was assessed at baseline, after acute treatment (2–4 days), and after longer-term treatment (21–28 days) with quetiapine. After 21–28 days of quetiapine treatment, HDRS scores significantly decreased from baseline measurements (P = 0.01). *P < 0.05 compared with baseline. Abbreviation: Hamilton Rating Scale for Depression.

Figure 4

Mean ± standard error of the CGI-S score over one month of quetiapine adjunctive treatment in 11 subjects. CGI-S score was assessed at baseline, after acute treatment (2–4 days) and after longer-term treatment (21–28 days) with quetiapine. After 21–28 days of quetiapine treatment, CGI-S scores significantly decreased from baseline measurements (P = 0.02). *P < 0.05 compared with baseline. Abbreviation: CGI-S, Clinical Global Impression Severity Scale.