P03-317 - Agomelatine Facilitates Benzodiazepine Discontinuation in Schizophrenia with Severe Insomnia

Abstract

We present the case of a schizophrenic patient with severe insomnia that had a partial response to high doses of benzodiazepines and sedating antipsychotics. Treatment with agomelatine allowed to suspend benzodiazepine treatment and restore quality of sleep. Case report: Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia. Conclusion: Agomelatine may be a valid treatment of insomnia in schizophrenia.

Role of Melatonin in Schizophrenia

“…There is an approved clinical trial designed to study BZD discontinuation with MLT in patients with schizophrenia [98]. As far as we know, the only paper published in which a MLT agonist (agomelatine) had been used to suspend BZD treatment in a schizophrenic patient treated with antipsychotics and a high dose of diazepam was published in 2010 [99]. Therefore, the small number of studies published on BZD discontinuation in schizophrenia precludes any definitive conclusion.…”