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Quetiapine for Tamoxifen-Induced Insomnia in Women With Breast Cancer

Received September 7, 2007; revised December 9, 2007; accepted January 11, 2008. From the Dept. of Psychiatric Science and Psychological Medicine, Psycho-oncology Unit, SAPIENZA University of Rome (Italy). Send correspondence and reprint requests to Massimo Pasquini, M.D., Dept. of Psychiatric Science and Psychological Medicine, Psycho-oncology Unit, SAPIENZA, University of Rome, Viale dell’Università 30, 00185, Rome, Italy. e-mail: massimo.pasquini{at}uniroma1.it
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Insomnia is a frequent adverse effect reported by women taking tamoxifen, an estradiol receptor-antagonist, for breast cancer. OBJECTIVE: The authors report on six patients treated with quetiapine, an atypical antipsychotic, for tamoxifen-related insomnia without depression. METHOD: Quetiapine was started at 25 mg/day 1 hour before bedtime; dose adjustments upward were made in 25-mg increments, titrated to a maximum dose of 100 mg according to therapeutic response and tolerance. RESULTS: Five of the six women showed a prompt improvement of their insomnia; this effect was maintained after 6 weeks of treatment. DISCUSSION: Quetiapine might improve sleep alterations because of its high affinity for serotonergic receptors, enhancing central serotonergic neurotransmission, thus possibly decreasing excitatory glutamatergic transmission.

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