Objective and subjective sleep quality: Melatonin versus placebo add-on treatment in patients with schizophrenia or bipolar disorder withdrawing from long-term benzodiazepine use

TY - JOUR

T1 - Objective and subjective sleep quality

T2 - Melatonin versus placebo add-on treatment in patients with schizophrenia or bipolar disorder withdrawing from long-term benzodiazepine use

AU - Baandrup, Lone

AU - Glenthøj, Birte Yding

AU - Jennum, Poul Jørgen

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2016/6/30

Y1 - 2016/6/30

N2 - Benzodiazepines are frequently long-term prescribed for the treatment of patients with severe mental illness. This prescribing practice is problematic because of well-described side effects including risk of dependence. We examined the efficacy of prolonged-release melatonin on objective and subjective sleep quality during benzodiazepine discontinuation and whether sleep variables were associated with benzodiazepine withdrawal. Eligible patients included adults with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder and long-term use of benzodiazepines in combination with antipsychotics. All participants gradually tapered the use of benzodiazepines after randomization to add-on treatment with melatonin versus placebo. Here we report a subsample of 23 patients undergoing sleep recordings (one-night polysomnography) and 55 patients participating in subjective sleep quality ratings. Melatonin had no effect on objective sleep efficiency, but significantly improved self-reported sleep quality. Reduced benzodiazepine dosage at the 24-week follow-up was associated with a significantly decreased proportion of stage 2 sleep. These results indicate that prolonged-release melatonin has some efficacy for self-reported sleep quality after gradual benzodiazepine dose reduction, and that benzodiazepine discontinuation is not associated with rebound insomnia in medicated patients with severe mental illness. However, these findings were limited by a small sample size and a low retention rate.

AB - Benzodiazepines are frequently long-term prescribed for the treatment of patients with severe mental illness. This prescribing practice is problematic because of well-described side effects including risk of dependence. We examined the efficacy of prolonged-release melatonin on objective and subjective sleep quality during benzodiazepine discontinuation and whether sleep variables were associated with benzodiazepine withdrawal. Eligible patients included adults with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder and long-term use of benzodiazepines in combination with antipsychotics. All participants gradually tapered the use of benzodiazepines after randomization to add-on treatment with melatonin versus placebo. Here we report a subsample of 23 patients undergoing sleep recordings (one-night polysomnography) and 55 patients participating in subjective sleep quality ratings. Melatonin had no effect on objective sleep efficiency, but significantly improved self-reported sleep quality. Reduced benzodiazepine dosage at the 24-week follow-up was associated with a significantly decreased proportion of stage 2 sleep. These results indicate that prolonged-release melatonin has some efficacy for self-reported sleep quality after gradual benzodiazepine dose reduction, and that benzodiazepine discontinuation is not associated with rebound insomnia in medicated patients with severe mental illness. However, these findings were limited by a small sample size and a low retention rate.

KW - Adult

KW - Antipsychotic Agents

KW - Benzodiazepines

KW - Bipolar Disorder

KW - Central Nervous System Depressants

KW - Double-Blind Method

KW - Female

KW - Humans

KW - Male

KW - Melatonin

KW - Middle Aged

KW - Polysomnography

KW - Psychotic Disorders

KW - Schizophrenia

KW - Sleep

KW - Sleep Initiation and Maintenance Disorders

KW - Substance Withdrawal Syndrome

KW - Withholding Treatment

KW - Journal Article

KW - Randomized Controlled Trial

U2 - 10.1016/j.psychres.2016.04.031

DO - 10.1016/j.psychres.2016.04.031

M3 - Journal article

C2 - 27107670

SN - 0165-1781

VL - 240

SP - 163

EP - 169

JO - Psychiatry Research

JF - Psychiatry Research

ER -