First-line treatment for insomnia should not include routine use of antipsychotics, say Canadian psychiatrists
Ottawa, ON, June 2, 2015— The routine use of antipsychotics, like Zyprexa (olanzapine) and Seroquel (quetiapine), should not be used to treat primary insomnia in children, adults or the elderly, say Canadian psychiatrists. This information is part of a series of 13 evidence-based recommendations made by the Canadian Psychiatric Association (CPA) and its working group partners, the Canadian Academy of Child and Adolescent Psychiatry (CACAP) and the Canadian Academy of Geriatric Psychiatry (CAGP), for the Choosing Wisely Canada campaign.
Choosing Wisely Canada (CWC) is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care.
“Many antipsychotics have sedative properties and are often prescribed off-label for complaints of insomnia,” says Dr. Chris Wilkes, president of the Canadian Academy of Child Adolescent Psychiatry (CACAP) and member of the CPA Board of Directors. “These drugs carry significant risk of potential side effects, including weight gain and metabolic disorders.”
Instead, the CWC psychiatry working group recommends that a thorough assessment to establish possible behavioural (e.g., poor sleep-wake schedule, use of caffeine and nicotine), emotional (e.g., stress), psychiatric, or physical (e.g., pain, sleep apnea) causes for insomnia be conducted. Nonpharmacological interventions, such as sleep hygiene techniques and behavioural modification, should be the first treatment option offered in most cases. Melatonin, an over-the-counter hormone supplement, may also be used to help regulate sleep-wake cycles.
“If pharmacotherapy is determined to be necessary, one of the approved agents to treat insomnia can be initiated, with an aim to use the lowest effective dose for the shortest period of time, and in conjunction with non-pharmacological strategies” says Dr. Wilkes. “Aggressive pharmacological interventions may offer symptomatic benefit in the short term, but may also lead to numerous potential complications in the long term.”
To date, nearly 100 national and provincial medical specialty societies, regional health collaboratives and patient and community partners have joined the conversations about appropriate care. With the release of these new lists, the campaign will have covered more than 150 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss.
“Conversations about what care patients truly need is a shared responsibility among all members of the health care team,” says Wendy Levinson, MD, Chair of Choosing Wisely Canada. “The Canadian Psychiatric Association’s Choosing Wisely Canada list will help psychiatrists across the country engage their patients in a dialogue about what care is best for them, and what we can do to reduce waste and overuse in our health care system.”
To learn more about Choosing Wisely Canada and to view the complete lists and additional details about the recommendations and evidence supporting them, visit www.ChoosingWiselyCanada.org.
The Canadian Psychiatric Association is the national voice for Canada’s 4,700 psychiatrists and more than 900 psychiatric residents. Founded in 1951, the CPA is dedicated to promoting an environment that fosters excellence in the provision of clinical care, education and research.
The Canadian Academy of Child and Adolescent Psychiatry is a national organization of child and adolescent psychiatrists and other professionals in Canada, committed to advancing the mental health of children, youth and families through promotion of excellence in care, advocacy, education, research and collaboration with other professionals.
The Canadian Academy of Geriatric Psychiatry is a national organization of psychiatrists dedicated to promoting mental health in the Canadian elderly population through the clinical, educational, research and advocacy activities of its membership. It was founded in 1991, and is recognized as the voice of Geriatric Psychiatry in Canada.
Choosing Wisely Canada is a campaign to help physicians and patients engage in healthy conversations about potentially unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care. It got underway initially in Ontario and has been endorsed by all provincial and territorial medical associations who have established mechanisms to support the adoption of the Choosing Wisely Canada recommendations. It is now a truly national campaign.