DOI: https://doi.org/10.36347/sjmcr.2025.v13i09.021

Pages: 2040-2042

This paper reports two clinical cases illustrating the potential for misuse and dependence on quetiapine, an atypical antipsychotic increasingly prescribed off-label, particularly for insomnia and anxiety. Both patients were women with psychiatric vulnerabilities (depressive disorders, substance use history) who initially received low-dose quetiapine for sleep problems. Over time, they self-escalated the dose to very high levels (600–800 mg/day), driven by perceived relief from anxiety and insomnia. One patient even changed the route of administration by smoking crushed tablets, seeking faster effects. The misuse led to psychological dependence, withdrawal symptoms upon dose reduction, and significant social and health consequences (weight gain, daytime sedation, social isolation, occupational instability). These patterns met the DSM-5 criteria for a substance use disorder. The cases highlight that quetiapine—although not traditionally classified as addictive—can be misused, especially in off-label prescriptions for vulnerable patients. The paper stresses the need for prescriber vigilance, careful risk–benefit assessment, monitoring for misuse, and prioritizing safer alternatives (e.g., cognitive-behavioral therapy, non-addictive medications) for sleep disorders.