advertisement
Home » Blogs » Bipolar Laid Bare » Combating Drowsiness Caused by Antipsychotics

Combating Drowsiness Caused by Antipsychotics

Combating Drowsiness Caused by AntipsychoticsAntipsychotics are frequently used to combat symptoms of bipolar disorder. Formerly used only during mood episodes, they are now prescribed to 60% of bipolar disorder patients as full-time, maintenance therapy. Doctors usually prescribe atypical, second generation antipsychotics for maintenance therapy as opposed to typical, first generation antipsychotics due to the latter carrying a much higher risk for side effects like paranoia, anxiety, tardive dyskinesia and dystonia. Atypical antipsychotics can also be more effective for treatment-resistant bipolar disorder. Second generation antipsychotics still carry a long list of side-effects, one of the most common being drowsiness.

Examples of atypical antipsychotics include:

  • aripiprazole (Abilify)
  • asenapine (Saphris)
  • cariprazine (Vraylar)
  • lurasidone (Latuda)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)

Drowsiness, also called sleepiness or somnolence, can be considered either a positive or a negative side effect, depending on the patient and their current state. Antipsychotics can act as sedatives during acute psychotic episodes.

During manic episodes, patients may experience sleeplessness in which they go without sleep for up to days at a time without feeling tired. Insomnia often occurs in periods of depression when patients want to sleep but aren’t able to do so. In these cases, drowsiness is a positive side effect in that it can help act as a sleep aid for patients.

When sleep is not necessarily the desired effect of taking an antipsychotic, drowsiness is considered a negative side effect. Some patients may only experience a minor sedative effect while others may struggle to stay awake when needed. When sleepiness is severe, it can be one of the major factors of patients discontinuing treatment. Sleepiness can cause problems socially and occupationally as well as being hazardous in situations when operating machinery or driving.

Antipsychotics cause drowsiness in much the same way that antihistamines do. Both types of drugs block histamine at H1 receptors. Histamine helps control the body’s sleep/wake cycle by producing and blocking certain types of histamine at different times during the day. Producing histamine promotes wakefulness and blocking histamine causes sleepiness. Antipsychotics affect other neurotransmitters in the brain involved in circadian rhythm like GABA and serotonin. Increasing either of these neurotransmitters decreases symptoms like anxiety, but can cause a sedative effect.

Some antipsychotics are more likely than others to cause drowsiness. A new analysis by Fang Fang et. al published in the journal CNS Drugs discusses the cause and severity of somnolence among the most common first and second generation antipsychotics as well as recommendations on how the side effect can be managed.

The researchers grouped the medications into three categories according to the severity of drowsiness as a side effect: high somnolence, moderate somnolence and low somnolence.

High somnolence:

  • clozapine (Clozaril)

Moderate somnolence:

  • olanzapine (Zyprexa)
  • perphenazine (Trilafon)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)

Low Somnolence

  • aripiprazole (Abilify)
  • asenapine (Saphris)
  • cariprazine (Vraylar)
  • haloperidol (Haldol)
  • lurasidone (Latuda)
  • paliperidone (Invega)

The researchers also included four recommendations on ways to combat the effects of drowsiness caused by antipsychotics in maintenance therapy.

1 Prescribe an antipsychotic with lower somnolence.

2 Reduce concurrent use of other drugs that may also cause drowsiness.

3 Wait for tolerance to build. After about two weeks the drowsiness effect should begin to wane.

4 Add a stimulant like modafinil (Provigil) or armodafinil (Nuvigil). This should be done with extreme caution as stimulants can induce mania or manic symptoms in people with bipolar disorder.

These recommendations assume ‘all things’ being equal in maintenance therapy. For instance, if a low somnolence drug is proving ineffective, one with a higher likelihood of drowsiness may need to be considered. It is up to patients and their doctors to find a medication that is both effective and tolerable for the patient. Otherwise patients may not adhere to treatment plans, therefore worsening the course of their bipolar disorder.

 

 

You can follow me on Twitter @LaRaeRLaBouff or find me on Facebook.

Image credit: Simon Law

Combating Drowsiness Caused by Antipsychotics

LaRae LaBouff


No comments yet... View Comments / Leave a Comment

 

 

APA Reference
LaBouff, L. (2016). Combating Drowsiness Caused by Antipsychotics. Psych Central. Retrieved on October 17, 2018, from https://blogs.psychcentral.com/bipolar-laid-bare/2016/07/combating-drowsiness-caused-by-antipsychotics/

 

Last updated: 21 Jul 2016
Last reviewed: By John M. Grohol, Psy.D. on 21 Jul 2016
Published on PsychCentral.com. All rights reserved.