The treatment of the depressive phase in patients with bipolar disorder (BD) is very difficult, said Roumen Milev, MD, Associate Professor and Chair, Division of Adult Treatment and Rehabilitation Psychiatry, Department of Psychiatry, Queen's University, Kingston, Ontario, Canada. Antidepressant therapy alone significantly increases the risk of triggering a manic or hypomanic episode, he added.

Atypical antipsychotics, which are known to be effective in the treatment of the manic phase of BD, have recently been shown to be effective in the depressive phase of the disorder. Quetiapine is also known to be effective in augmenting the treatment of severe bipolar mania.

Dr. Milev and colleagues investigated the use of quetiapine in the adjunctive treatment of bipolar depression in a small, open-label trial.

The dose of quetiapine was titrated individually to a maximum of 800 mg/day. The primary evaluation tools were the 21-item Hamilton Depression Rating Scale (HAM-D21) and the Young Mania Rating Scale (YMRS).

The researchers enrolled six men and 13 women with either bipolar I or II disorder. The average age of the patients was 49.4 years (range 26 to 70). One patient received quetiapine monotherapy plus cognitive behavioural therapy (CBT), three were on an antidepressant, three were on a mood stabilizer and nine were using both. Seven patients were also taking sedatives. All patients reported suicidal ideation, and six had previously attempted suicide.

Scores on the YMRS remained low and stable during the 12-month trial. HAM-D21 scores, however, decreased from a baseline of 27.2 to 14.2 in the first month, and remained low for the duration of the study. At 12 months, the mean HAM-D21 score was 12.6.

Patients gained an average of 3.3 kg during the study, said Dr. Milev, which increased the mean body mass index from 32.5 to 33.6.

Drug-associated adverse events were common, he said. Of 72 reported events, 61.1% were minor and 34.7% were moderate. There were three serious adverse events.

Dr. Milev concluded that quetiapine seems to be efficacious and well tolerated, and is a viable adjunctive therapy for the treatment of bipolar depression.


[Presentation title: Adjunct Quetiapine for Bipolar Depression: Twelve-Month Open Label Prospective Trial. Abstract P-08]

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