Abstract
Somnolence is a common side effect of antipsychotics, although not all agents have the same sedative properties. Antipsychotic-induced somnolence can be managed by selecting a lower-risk agent, initiating treatment at a lower dose with a slower titration and minimizing the use of concurrent somnolence-inducing agents. Good sleep hygiene is also vital. Although data are limited, caffeine, bupropion and stimulants, such as modafinil, armodafinil, amphetamines and methylphenidate, may be useful in treating antipsychotic-induced somnolence.
Similar content being viewed by others
References
Fang F, Sun H, Wang Z, et al. Antipsychotic drug-induced somnolence: incidence, mechanisms, and management. CNS Drugs. 2016;30(9):845–67.
Miller DD. Sedation with antipsychotics: manage, don’t accept adverse ‘calming’ effect. Curr Psychiatry. 2007;6(8):38–51.
España RA, Scammell TE. Sleep neurobiology from a clinical perspective. Sleep. 2011;34(7):845–58.
Bondolfi G, Dufour H, Patris M, et al. Risperidone versus clozapine in treatment-resistant chronic schizophrenia: a randomized double-blind study. The Risperidone Study Group. Am J Psychiatry. 1998;155(4):499–504.
Azorin JM, Spiegel R, Remington G, et al. A double-blind comparative study of clozapine and risperidone in the management of severe chronic schizophrenia. Am J Psychiatry. 2001;158(8):1305–13.
Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. 2003;60(1):82–9.
Potkin SG, Saha AR, Kujawa MJ, et al. Aripiprazole, an antipsychotic with a novel mechanism of action, and risperidone vs placebo in patients with schizophrenia and schizoaffective disorder. Arch Gen Psychiatry. 2003;60(7):681–90.
Kane JM, Carson WH, Saha AR, et al. Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizophrenia and schizoaffective disorder. J Clin Psychiatry. 2002;63(9):763–71.
Kane JM, Cohen M, Zhao J, et al. Efficacy and safety of asenapine in a placebo- and haloperidol-controlled trial in patients with acute exacerbation of schizophrenia. J Clin Psychopharmacol. 2010;30(2):106–15.
Meltzer HY, Cucchiaro J, Silva R, et al. Lurasidone in the treatment of schizophrenia: a randomized, double-blind, placebo- and olanzapine-controlled study. Am J Psychiatry. 2011;168(9):957–67.
Loebel A, Cucchiaro J, Sarma K, et al. Efficacy and safety of lurasidone 80 mg/day and 160 mg/day in the treatment of schizophrenia: a randomized, double-blind, placebo- and active-controlled trial. Schizophr Res. 2013;145(1–3):101–9.
Davidson M, Emsley R, Kramer M, et al. Efficacy, safety and early response of paliperidone extended-release tablets (paliperidone ER): results of a 6-week, randomized, placebo-controlled study. Schizophr Res. 2007;93(1–3):117–30.
Kane J, Canas F, Kramer M, et al. Treatment of schizophrenia with paliperidone extended-release tablets: a 6-week placebo-controlled trial. Schizophr Res. 2007;90(1–3):147–61.
Marder SR, Kramer M, Ford L, et al. Efficacy and safety of paliperidone extended-release tablets: results of a 6-week, randomized, placebo-controlled study. Biol Psychiatry. 2007;62(12):1363–70.
Canuso CM, Dirks B, Carothers J, et al. Randomized, double-blind, placebo-controlled study of paliperidone extended-release and quetiapine in inpatients with recently exacerbated schizophrenia. Am J Psychiatry. 2009;166(6):691–701.
McIntyre RS, Cohen M, Zhao J, et al. Asenapine in the treatment of acute mania in bipolar I disorder: a randomized, double-blind, placebo-controlled trial. J Affect Disord. 2010;122(1–2):27–38.
Sachs GS, Greenberg WM, Starace A, et al. Cariprazine in the treatment of acute mania in bipolar I disorder: a double-blind, placebo-controlled, phase III trial. J Affect Disord. 2015;174:296–302.
Tohen M, Goldberg JF, Gonzalez-Pinto Arrillaga AM, et al. A 12-week, double-blind comparison of olanzapine vs haloperidol in the treatment of acute mania. Arch Gen Psychiatry. 2003;60(12):1218–26.
Vieta E, Nuamah IF, Lim P, et al. A randomized, placebo- and active-controlled study of paliperidone extended release for the treatment of acute manic and mixed episodes of bipolar I disorder. Bipolar Disord. 2010;12(3):230–43.
McIntyre RS, Brecher M, Paulsson B, et al. Quetiapine or haloperidol as monotherapy for bipolar mania: a 12-week, double-blind, randomised, parallel-group, placebo-controlled trial. Eur Neuropsychopharmacol. 2005;15(5):573–85.
Smulevich AB, Khanna S, Eerdekens M, et al. Acute and continuation risperidone monotherapy in bipolar mania: a 3-week placebo-controlled trial followed by a 9-week double-blind trial of risperidone and haloperidol. Eur Neuropsychopharmacol. 2005;15(1):75–84.
Vieta E, Ramey T, Keller D, et al. Ziprasidone in the treatment of acute mania: a 12-week, placebo- controlled, haloperidol-referenced study. J Psychopharmacol. 2010;24(4):547–58.
Dell’Osso B, Ketter TA. Use of adjunctive stimulants in adult bipolar depression. Int J Neuropsychopharmacol. 2013;16(1):55–68.
Scammell TE, Estabrooke IV, McCarthy MT, et al. Hypothalamic arousal regions are activated during modafinil-induced wakefulness. J Neurosci. 2000;20(22):8620–8.
Saavedra-Velez C, Yusim A, Anbarasan D, et al. Modafinil as an adjunctive treatment of sedation, negative symptoms, and cognition in schizophrenia: a critical review. J Clin Psychiatry. 2009;70(1):104–12.
Author information
Authors and Affiliations
Consortia
Ethics declarations
The article was adapted from CNS Drugs 2016;30(9):845–67 [1] by salaried employees of Adis/Springer and was not supported by any external funding.
Rights and permissions
About this article
Cite this article
Adis Medical Writers. When managing antipsychotic-induced somnolence, consider using lower-risk agents and promoting good sleep hygiene. Drugs Ther Perspect 33, 222–226 (2017). https://doi.org/10.1007/s40267-017-0383-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40267-017-0383-0