Quetiapine Effective Against Anxiety in Bipolar Depression

Paula Moyer, MA

May 07, 2004

May 7, 2004 (New York) — The atypical antipsychotic quetiapine (Seroquel) is effective in treating the anxiety symptoms associated with bipolar depression, according to findings presented here at the 157th annual meeting of the American Psychiatric Association.

"This is the first time that an antipsychotic has been shown to have clear antidepressant activity," senior investigator Joseph R. Calabrese, MD, told Medscape in a telephone interview. "Treatment separated from placebo on every outcome. I was surprised to see how large the effect was. It seems to me that this drug is not just an antipsychotic. It separated from placebo on nine of 10 items, compared to olanzapine, which separates from placebo in three items when assessed as a treatment for bipolar depression." Dr. Calabrese is a professor of psychiatry at Case Western Reserve University in Cleveland, Ohio.

In a study funded by AstraZeneca, the manufacturer of quetiapine, the investigators sought to evaluate the efficacy and safety of quetiapine monotherapy for anxiety symptoms in patients with bipolar depression. The study involved 511 patients, 342 with bipolar I disorder and 169 with bipolar II disorder, all of whom were experiencing depression. Patients were randomized in a double-blind fashion to receive eight weeks of treatment with quetiapine, 300 mg or 600 mg daily, or placebo. The investigators assessed anxiety with the Hamilton Rating Scale for Anxiety (HAM-A). At baseline the scores were similar across groups, ranging from 18.6 to 18.9.

Patients in the quetiapine groups improved significantly in the HAM-A score compared with those in the placebo group (P < .05). This difference held at every evaluation starting with the first at day 8 and continuing throughout the study, at which point the 300-mg group had a mean HAM-A score reduction of 8.6, the 600 mg group's score reduction averaged 8.7, and the placebo group had an average score reduction of 5.5.

"We don't know if this was a drug-specific effect or a class effect," said Norman Sussman, MD, in a telephone interview seeking outside comment. "The findings show that quetiapine might be an option in treating the anxiety component of bipolar depression." He is a professor of psychiatry at New York University School of Medicine with a special interest in psychopharmacology.

In a separate study, investigators found that early diagnosis of bipolar disorder in college-age students was associated with improved outcome.

"This was the first time that we reviewed college-age students," said senior investigator Terence A. Ketter, MD in a telephone interview. "We're very interested in finding ways to intervene early in bipolar disorder. Our review showed that if you get in early and treat these patients, you can improve outcomes. For example, because they are more likely to present with depression before they have a manic episode, a thorough medical history and family history may prevent a routine antidepressant prescription and the subsequent rapid cycling." He is an associate professor of psychiatry at Stanford University Medical Center in Stanford, California, where he is chief of the bipolar disorders clinic.

In this retrospective chart review, the investigators tracked the course of 42 patients with bipolar disorder, 24 patients with type I, 11 patients with type II, and seven not specified. The patients were an average of 21.9 years old and half were women. They had been treated for an average of 1.8 years and were an average of 16.1 years old at the onset of their illness, with a duration prior to diagnosis of 5.9 years. The group was receiving an average of 2.3 psychotropic medications per patient.

Of the students, 64% had had a previous psychiatric hospitalization and 26% had attempted suicide. Most (63%) had anxiety disorders, 43% used marijuana, and 37% reported alcohol abuse. Most patients (68%) had first been treated for depression, with half receiving unopposed antidepressants. Of those receiving such treatments, 67% had pharmacologic hypomania compared with 21% in those receiving other treatments (P<0.01).

As the patients were followed over time, the Clinical Global Impression (CGI) score improved from 3.3 to 2.4 (P < .005), the Global Assessment of Function score increased from 59 to 67 (P < .005), and the percentage of patients in syndromal episodes fell from 48% to 12%. Of the 14% of students who had to be hospitalized while in college, all had prior hospitalizations; similarly, of the 7% who made suicide attempts, all were patients with prior attempts. At the last visit, each patient was receiving an average of 2.46 psychotropic medications.

"[This] study of college students reaffirms that people with bipolar disorder present with depression before they get manic," Dr. Sussman commented. "However, this does not mean that every young person with depression should get a mood stabilizer along with an antidepressant. It means that the treating physician needs to get a thorough history of the patient and the patient's family, and to ask about bipolar disorder as well as substance abuse."

APA 157th Annual Meeting: Abstract NR743, presented May 5, 2004; abstract 31, presented May 3, 2004.

Reviewed by Gary D. Vogin, MD

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