PEP Topic 
Sleep-Wake Disturbances

Quietiapine is an antipsychotic that has been used to treat schizophrenia and biopolar disorder. It  is a dopamine, serotonin, and adrenergic antagonist and a potent antihistamine.  Quietiapine was studied in patients with cancer for its effect on sleep disturbance.

Effectiveness Not Established

Research Evidence Summaries

Pasquini, M., Speca, A., & Biondi, M. (2009). Quetiapine for tamoxifen-induced insomnia in women with breast cancer. Psychosomatics, 50, 159–161.

doi: 10.1176/appi.psy.50.2.159

Study Purpose:

To determine if quetiapine, an atypical antipsychotic, would improve insomnia in patients with breast cancer being treated with tamoxifen (tamoxifen-related insomnia).

Intervention Characteristics/Basic Study Process:

Quetiapine was initiated at 25 mg/day, given one hour before bedtime. Dosages were titrated up to 100 mg/day based on patient tolerance and response to medication. Patients were assessed using tools for depression and insomnia at baseline and weeks 1 and 6 weeks into therapy.

Sample Characteristics:

  • The sample was comprised of six women.
  • Age ranged from 38 to 52 years.
  • Patients were women with localized breast cancer (stage II–III-A) receiving tamoxifen (20 mg) 3 to 12 months after definitive primary therapy, including adjuvant chemotherapy and radiotherapy.
  • Four of six patients were married.
  • Patients had taken no psychotropic medications in the preceding month.


  • Single site  
  • Italy

Phase of Care and Clinical Applications:

Patients were undergoing the transition phase of care after initial treatment.

Study Design:

This was a single-group, repeated measure, case study.

Measurement Instruments/Methods:

  • Structured Clinical Interview for DSM-IV (SCID-I)
  • Beck Depression Inventory (BDI)
  • Hamilton Rating for Depression (HAM-D)
  • Insomnia Severity Index (ISI), Italian version


Five of six patients had rapid (at one week) improvement in insomnia based on ISI scores. This effect maintained improvement at six weeks.


Quetiapine may be a useful agent in treating tamoxifen-related or tamoxifen-induced insomnia in women with breast cancer.


  • This was a case study or case report only.
  • The study had a small sample size.
  • No statistical analysis was performed.
  • The study lacked biobehavioral assessments and objective sleep measures.
  • Dosages of quetiapine were variable.

Nursing Implications:

Quetiapine, an atypical antipsychotic, may be a potential option for treating tamoxifen-related insomnia without depression. A larger study is required.