Quetiapine Alone and Added to a Mood Stabilizer for Serious Mood Disorders
J Clin Psychiatry 2001;62(9):728-732
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Background: Use of antipsychotic medication
intermittently or over the long term may be necessary in treating
patients with bipolar disorder whose symptoms have responded
suboptimally to standard mood-stabilizing agents. Quetiapine
fumarate is an effective novel antipsychotic with mixed
serotonergic (5-HT2) and dopaminergic (D2)
activity. This is an open-label, 12-week
prospective study to assess the efficacy and tolerability of
quetiapine in the treatment of patients with bipolar and
schizoaffective disorder who were suboptimally responsive to mood
Method: Participants in the study were
inpatients or outpatients with a DSM-IV diagnosis of bipolar or
schizoaffective disorder. Baseline psychopathology was evaluated
with the Brief Psychiatric Rating Scale (BPRS), the Young Mania
Rating Scale (YMRS), and the Hamilton Rating Scale for Depression
(HAM-D). Involuntary movements were rated with the Simpson-Angus
Neurologic Rating Scale. Quetiapine was added on an open-label
basis and increased to optimum clinical dosage. Psychopathology
and Abnormal Involuntary Movement Scale ratings were repeated
weekly for the first 4 weeks and then again at weeks 8 and 12.
Results: Ten individuals with bipolar disorder
and 10 with schizoaffective disorder received quetiapine therapy.
Overall, patients improved, with significant improvement in BPRS
(p < .001), YMRS (p = .043), and HAM-D scores (p = .002).
Simpson-Angus score also significantly decreased (p = .02).
Overall, quetiapine was well tolerated by patients in this group
with serious mood disorders. The mean ± SD quetiapine dose was
202.9 ± 124.3 mg/day (range, 50-400 mg/day). Mean weight gain
was 10.9 lb (4.9 kg).
Conclusion: Although limited by its small size,
open-label design, and relative gender homogeneity, this study
suggests that quetiapine therapy may be useful in the treatment
of individuals with serious mood disorders who aresuboptimally
responsive to mood stabilizers alone. These
preliminary findings should be explored in larger, controlled