Jennifer Hilliard ScottInsomnia affects up to half of people with schizophrenia and is thought to worsen the impact of their disease, including their risk of suicide. A new meta-analysis of the antipsychotics these patients take indicates those who take clozapine have significantly fewer problems with insomnia, investigators report.
Insomnia and suicide risk have been linked in schizophrenia, and clozapine is the only antipsychotic with a Food and Drug Administration indicator for reducing suicide risk, says Brian Miller, MD, psychiatrist and schizophrenia expert at the Medical College of Georgia.
MCG investigators say it’s plausible that clozapine’s ability to essentially double patients’ ability to sleep versus other antipsychotics helps explain the reduced suicide risk. Insomnia has been found to generally worsen schizophrenia symptoms and complications from obesity to depression.
However, clozapine, which has a small risk of big side effects including inflammation of the heart muscle and an acute, severe drop in immune cells that can leave patients vulnerable to life-threating infections, is typically only used in patients with treatment-resistant schizophrenia, not as a first-line therapy, says Miller, who has dozens of these patients taking clozapine.
The MCG investigators performed what appears to be the first systematic review of insomnia in patients with schizophrenia that looked at the impact of clozapine versus other antipsychotics. They reviewed information on 1,952 patients enrolled in eight clinical trials that included 922 people treated with clozapine and the remainder with other first-line antipsychotics, like risperidone and olanzapine.
They found each of the other antipsychotics associated with increased odds of having insomnia compared to clozapine; overall a 2.2-fold increased risk.
