Catia Martins, Hugo Almeida and Serafim Carvalho
Hospital de Magalhaes Lemos, Portugal
Posters & Accepted Abstracts: Clin Exp Psychol
Objectives: Presenting a case-report of insomnia treated with off-label medication.
Background & Aims: Treatment of chronic primary insomnia is still a matter of debate. The recommended pharmacological approach is limited to short-term use, leaving cases of chronic primary insomnia to offlabel prescriptions or other therapeutic approaches. The authors present a successful case of chronic insomnia pharmacological treatment.
Material & Methods: Clinical data about the patient and research on PubMed (last 5 years publications) with the keywords“insomnia off-label prescription”and “insomnia off-label”.
Results: 61-year-old man, presenting with complaints of insomnia and poor quality of sleep with 10 years of evolution, medicated with several benzodiazepines over the years, with poor or no response. No stressful life-events reported. Polysomnography revealed 64% sleep efficiency without breathing irregularities, cardiac rhythm abnormalities or leg movements. Personality evaluation showed traits of obsessivity and a tendency to somatization. He preferred offlabel prescription over psychotherapy and was treated with fluvoxamine 150mg/day, clonazepam 2mg/day with only partial response after 1 month. Olanzapine 5mg/day was added and total remission occurred immediately. After one year, the patient decided to progressively reduce fluvoxamine to 50mg/day which resulted in relapse. The previous effective medication was reinstated and symptoms remitted completely in one month.
Conclusions: New pharmacological combinations may be effective for chronic insomnia, but warrant further investigation. An integrative perspective of insomnia, considering patient’s coping strategies and personality traits, may help better conceptualize the problem, and bring innovative therapeutic strategies.