quetiapine-fumarate and Depressive-Disorder

This paper reviews recent research on late-life depression (LLD) pharmacotherapy, focusing on updated information for monotherapy and augmentation treatments. We then review new research on moderators of clinical response and how to use the information for improved efficacy.. A recent review shows that sertraline, paroxetine, and duloxetine were superior to placebo for the treatment of LLD. There is concern that paroxetine could have adverse outcomes in the geriatric population due to anticholinergic properties; however, studies show no increases in mortality, dementia risk, or cognitive measures. Among newer antidepressants, vortioxetine has demonstrated efficacy in LLD, quetiapine has demonstrated efficacy especially for patients with sleep disturbances, and aripiprazole augmentation for treatment resistance in LLD was found to be safe and effective. Researchers have also been identifying moderators of LLD that can guide treatment. Researchers are learning how to associate moderators, neuroanatomical models, and antidepressant response. SSRI/SNRIs remain first-line treatment for LLD. Aripiprazole is an effective and safe augmentation for treatment resistance. Studies are identifying actionable moderators that can increase treatment response.

Topics: Antidepressive Agents; Aripiprazole; Depression; Depressive Disorder; Drug Resistance; Duloxetine Hydrochloride; Humans; Paroxetine; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors; Serotonin and Noradrenaline Reuptake Inhibitors; Sertraline; Vortioxetine

Herein we review the evidence supporting Food and Drug Administration (FDA) approved and emerging treatments for bipolar depression.. A PubMed search of all English-language articles published up to July 2013 was conducted. The search terms were quetiapine, olanzapine-fluoxetine, olanzapine, lurasidone, ketamine, modafinil/armodafinil, and lamotrigine. The search was augmented with a manual review of relevant article reference lists, as well as posters presented at national and international meetings. Articles selected for review were based on the adequacy of sample size, the use of standardized diagnostic instruments, validated assessment measures, and overall manuscript quality.. Olanzapine-fluoxetine combination (OFC), quetiapine, and lurasidone are FDA-approved for the acute treatment of bipolar depression. Lurasidone is the most recently approved agent for bipolar depression. Olanzapine-fluoxetine combination and quetiapine are approved as single modality therapies while lurasidone is approved as a monotherapy and as an adjunct to lithium or divalproex. The overall effect size of the 3 treatments in mitigating depressive symptoms is similar. Clinically significant weight gain and metabolic disruption as well as sedation are significant limitations of OFC and quetiapine. The minimal propensity for weight gain as well as the metabolic neutrality of lurasidone in the bipolar population is a clinically significant advantage. Evidence also supports lamotrigine with compelling evidence as an adjunct to lithium and in recurrence prevention paradigm; suggested evidence also exists for ketamine and modafinil/armodafinil; notwithstanding, these treatments remain investigational.. Relatively few agents are FDA-approved for bipolar depression. The selection and sequencing of agents in bipolar depression should give primacy to those agents that are FDA-approved. Further refinement of the selection process will need to pay careful attention to the relative hazards of weight gain and metabolic disruption in this highly susceptible population. Other agents with differential mechanisms (eg, ketamine) offer a promising alternative in bipolar depression.

Topics: Antidepressive Agents; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzhydryl Compounds; Benzodiazepines; Bipolar Disorder; Central Nervous System Stimulants; Depressive Disorder; Dibenzothiazepines; Drug Approval; Drug Combinations; Excitatory Amino Acid Antagonists; Fluoxetine; Humans; Isoindoles; Ketamine; Lamotrigine; Lurasidone Hydrochloride; Modafinil; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors; Thiazoles; Triazines; United States; United States Food and Drug Administration

Treatment of acute mania with second-generation antipsychotics has been claimed to involve a lower risk of switch to depression than haloperidol. However, clinical guidelines clearly state that this is not a proven fact.. Meta-analysis of double-blind randomized controlled trials in acute mania, comparing rates of switch to depression with atypical antipsychotics and with haloperidol. Search was conducted in MEDLINE and CENTRAL databases (last search: September 2011).. 8 randomized clinical trials fulfilled inclusion criteria. 2 of them were excluded because of low methodological quality or lack of data. 5 second-generation antipsychotics (aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone) were compared to haloperidol. In the mixed effects model the Risk Ratio for depressive switch was 0.71 (0.52, 0.96) favouring atypical antipsychotics. In the random effects model the difference did not reach statistical significance. In the heterogeneity analysis, exclusion of an outlying aripiprazole trial yielded a Risk Ratio of 0.58 (0.42, 0.82) with a non-significant heterogeneity test. Although no atypical antipsychotic was individually significantly superior to haloperidol, a trend could be seen favouring olanzapine (RR=0.56 [0.29, 1.08]), quetiapine (RR=0.36 [0.10, 1.33]), and ziprasidone (RR=0.51 [0.22, 1.18]).. All trials were industry supported, with some variability in dosage of haloperidol. Switch to depression was not the primary outcome of the trials. Heterogeneity could be explained as a lack of class-effect for atypicals.. Treating acute mania with atypicals is associated to 42% less risk of switch to depression than with haloperidol. Nevertheless, caution should be taken when considering this a class effect, as only olanzapine, quetiapine, and ziprasidone may show a better profile.

Topics: Acute Disease; Antimanic Agents; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Bipolar Disorder; Depression; Depressive Disorder; Dibenzothiazepines; Double-Blind Method; Drug Industry; Haloperidol; Humans; Olanzapine; Piperazines; Quetiapine Fumarate; Quinolones; Randomized Controlled Trials as Topic; Research Support as Topic; Risperidone; Thiazoles

This article reviews the role of the second generation antipsychotics in the treatment of affective disorders. The treatment of major depressive disorders and the acute and long-term treatment of bipolar affective disorders are also discussed. After the special role of quetiapine is highlighted, a novel psychopharmacological terminology and nomenclature are also introduced.

Topics: Antidepressive Agents, Second-Generation; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Humans; Mood Disorders; Psychopharmacology; Quetiapine Fumarate; Randomized Controlled Trials as Topic

Topics: Adult; Anticonvulsants; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Drug Combinations; Female; Fluoxetine; Humans; Lamotrigine; Olanzapine; Practice Guidelines as Topic; Psychotherapy; Quetiapine Fumarate; Triazines

Priapism is characterized by a prolonged and painful erection in the absence of sexual desire and arousal. Priapism is a rare and serious side effect of psychotropic drugs, and is thought to be attributable to blockage of alpha-1 adrenergic receptors in the corpus cavernosum. Although priapism is commonly associated with typical antipsychotics, there are some (but not many) case reports of priapism due to atypical antipsychotics. This side effect has been reported in patients taking ziprasidone, risperidone, clozapine, quetiapine, aripiprazole, and olanzapine. Not all antipsychotics bind to alpha-1 adrenergic receptors with the same intensity; as compared to other antipsychotics, quetiapine has an intermediate affinity. Priapism could be considered an idiosyncratic reaction, because it is correlated neither with the dose nor duration of psychotropic drug use. Herein we present a case of priapism caused by a single 300-mg dose of quetiapine, and a brief review priapism in the light of this case.

Topics: Administration, Oral; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Drug Administration Schedule; Humans; Male; Middle Aged; Priapism; Quetiapine Fumarate

Quetiapine, an atypical antipsychotic, has been approved for the treatment of schizophrenia, acute mania, bipolar depression and unipolar major depression. However, it is often used (off-label) to treat other depressive disorders and anxiety disorders in children and adults.. This article reviews the evidence for the safety and efficacy of quetiapine in these populations, as both monotherapy and augmentation to other psychotropics.. This article provides an in-depth review of the published literature on the topic and also provides recommendations for use.. There is strong evidence to support the use of quetiapine in major depressive and generalized anxiety disorders, and preliminary support for treatment-resistant and psychotic depression. There is reasonable evidence of its benefits as an augmenting agent in obsessive-compulsive disorder, while data in other anxiety disorders are limited but promising. While long-term tolerability data are limited, quetiapine appears well tolerated in the short-term. Further randomized controlled trials are needed to confirm the efficacy and tolerability of quetiapine, both short- and long-term, in many of these conditions.

Topics: Adolescent; Adult; Antipsychotic Agents; Anxiety Disorders; Child; Comorbidity; Depressive Disorder; Dibenzothiazepines; Drug Resistance; Drug Therapy, Combination; Female; Humans; Male; Quetiapine Fumarate; Randomized Controlled Trials as Topic

Although the possibilities of antidepressive pharmacotherapy are continuously improving, the rate of nonresponders or partial responders is still relatively high. Suicidal behaviour, the most tragic consequence of untreated or unsuccessfully treated depression, commonly develops in the first few weeks of antidepressive treatment before the onset of therapeutic action and is strongly related to certain specific symptoms of depression like anxiety, agitation and insomnia. The present paper reviews the newly discovered and well-documented antidepressive effect of quetiapine in bipolar and unipolar depression with special regards to its early onset of action, and its sleep-improving effects. Both beneficial effects play an important role in the reduction of suicidal risk frequently seen in depressed patients.

Topics: Antidepressive Agents; Antipsychotic Agents; Delayed-Action Preparations; Depressive Disorder; Dibenzothiazepines; Humans; Quetiapine Fumarate; Sleep; Suicide Prevention; Treatment Outcome

Atypical antipsychotics offer broader efficacy and improved tolerability compared with conventional agents. Many patients currently treated with conventional antipsychotics continue to experience persistent symptoms or troublesome side effects and may benefit from a change to one of the newer atypical agents. There are also significant differences in the side-effect profiles of the atypicals, such that a switch from one atypical agent to another could offer advantages to many patients. Unfortunately, many clinicians remain uncertain about the switching process and are reluctant to initiate change. The aim of this review is to identify the indications for a switch in antipsychotic therapy with a focus on recent switching data for the atypical antipsychotic, quetiapine. The clinical aspects of quetiapine's receptor binding characteristics are reviewed including the implications of the low D(2) antagonist properties that make quetiapine the treatment of choice when EPS persists with other atypical antipsychotics. Practical guidelines are given for managing the process of changeover, for avoiding pitfalls and for maximizing the chances of a successful switch. For example, when managing the antipsychotic crossover, it is important to consider the psychological effects of switching arising from symptom and side-effect changes. Finally, advice is provided on the assessments necessary when evaluating the success of a change in therapy, together with guidance on the optimal duration of treatment trials.

Topics: Animals; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Dyskinesia, Drug-Induced; Humans; Psychotic Disorders; Quetiapine Fumarate

As many as half of obsessive-compulsive disorder (OCD) patients treated with an adequate trial of serotonin reuptake inhibitors (SRIs) fail to fully respond to treatment and continue to exhibit significant symptoms. Many studies have assessed the effectiveness of antipsychotic augmentation in SRI-refractory OCD. In this systematic review, we evaluate the efficacy of antipsychotic augmentation in treatment-refractory OCD. The electronic databases of PubMed, PsychINFO (1967-2005), Embase (1974-2000) and the Cochrane Central Register of Controlled Trials (CENTRAL, as of 2005, Issue 3) were searched for relevant double-blind trials using keywords 'antipsychotic agents' or 'neuroleptics' and 'obsessive-compulsive disorder'. Search results and analysis were limited to double-blind, randomized control trials involving the adult population. The proportion of subjects designated as treatment responders was defined by a greater than 35% reduction in Yale Brown Obsessive-Compulsive Scale (Y-BOCS) rating during the course of augmentation therapy. Nine studies involving 278 participants were included in the analysis. The meta-analysis of these studies demonstrated a significant absolute risk difference (ARD) in favor of antipsychotic augmentation of 0.22 (95% confidence interval (CI): 0.13, 0.31). The subgroup of OCD patients with comorbid tics have a particularly beneficial response to this intervention, ARD=0.43 (95% CI: 0.19, 0.68). There was also evidence suggesting OCD patients should be treated with at least 3 months of maximal-tolerated therapy of an SRI before initiating antipsychotic augmentation owing to the high rate of treatment response to continued SRI monotherapy (25.6%). Antipsychotic augmentation in SRI-refractory OCD is indicated in patients who have been treated for at least 3 months of maximal-tolerated therapy of an SRI. Unfortunately, only one-third of treatment-refractory OCD patients show a meaningful treatment response to antipsychotic augmentation. There is sufficient evidence in the published literature, demonstrating the efficacy of haloperidol and risperidone, and evidence regarding the efficacy of quetiapine and olanzapine is inconclusive. Patients with comorbid tics are likely to have a differential benefit to antipsychotic augmentation.

Topics: Adult; Aged; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Comorbidity; Depressive Disorder; Dibenzothiazepines; Double-Blind Method; Drug Resistance; Drug Therapy, Combination; Haloperidol; Humans; Middle Aged; Obsessive-Compulsive Disorder; Olanzapine; Patient Dropouts; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Risperidone; Selective Serotonin Reuptake Inhibitors; Tic Disorders; Treatment Outcome

The use of at least one mood-stabilizing agent is common clinical practice in the treatment of bipolar disorder, regardless of the treatment setting or disease phase. However, a consensus definition of 'mood stabilizer' remains to be established. A mood stabilizer has been operationally described as an agent that is useful in at least one phase of bipolar disorder while not worsening any other phase of the illness. More stringent definitions have been proposed, and it can be argued that a clinically effective mood stabilizer would have efficacy in a broad range of affective, psychotic, behavioral and cognitive domains in all phases of bipolar disorder and would be well tolerated across a range of doses for sustained periods. Clinically effective mood stabilizers should treat mania and depression, while preventing recurrence and improving quality of life. Effective treatment should not precipitate mania, depression, or rapid cycling, and should minimize the burden of treatment-emergent side effects. Data from clinical studies of quetiapine are reviewed in context with the literature discussing traditional and emerging mood stabilizers. Using a liberal definition, the evidence for quetiapine qualifies it as a bimodal mood stabilizer based on its demonstrated effectiveness in the treatment of bipolar mania and depression. Further data suggest that quetiapine has promise across all phases of bipolar disorder with the potential to meet even the most stringent definitions of a mood stabilizer.

Topics: Affect; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Humans; Long-Term Care; Quetiapine Fumarate

Although quetiapine was introduced as an atypical antipsychotic drug with clinical efficacy in schizophrenia patients, it has been used in a variety of disease states over the last 5 years. The most common conditions have included mood and anxiety disorders, obsessive-compulsive disorder, aggression, hostility, posttraumatic stress disorder, borderline personality disorder, delirium, and comorbid substance abuse. Considering its efficacy in a wide variety of neuropsychiatric conditions and its excellent tolerability profile, quetiapine could emerge as a broad-spectrum psychotropic medication that may be helpful in psychiatry across various diagnostic categories. Traditionally, studies on the predictive validity of psychiatric disorders help with nosologic issues and controversies. Assessing quetiapine's tolerability and its overall treatment response might help tease out the predictive validity of various psychiatric syndromes (based currently on an atheoretical descriptive approach) and may shape psychiatric nosology in the future. Quetiapine's low affinity and fast dissociation from postsynaptic dopamine-2 receptors give the least risk of producing acute extrapyramidal side effects, tardive dyskinesia, and neuroleptic malignant syndrome. These factors suggest that the clinical utility of quetiapine in psychiatric conditions other than schizophrenia has not been fully exploited thus far.

Topics: Adult; Aggression; Antipsychotic Agents; Anxiety Disorders; Bipolar Disorder; Borderline Personality Disorder; Clinical Trials as Topic; Comorbidity; Delirium; Depressive Disorder; Dibenzothiazepines; Forecasting; Hostility; Humans; Mental Disorders; Obsessive-Compulsive Disorder; Quetiapine Fumarate; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Treatment Outcome

Depressive symptoms and syndromal depression commonly occur in patients with schizophrenia. Schizophrenia is also associated with aggression directed at self and others. For this article, the available literature regarding the efficacy of clozapine, risperidone, olanzapine, quetiapine, and ziprasidone in the treatment of depression, hostility, and suicidality in patients with schizophrenia was reviewed. These studies suggest that atypical antipsychotics may exert therapeutic effects on depression and hostility as well as psychosis and that clozapine and olanzapine may reduce suicidality in patients with schizophrenia. These therapeutic actions appear to represent additional advantages of atypical antipsychotics compared with standard agents.

Topics: Aggression; Antipsychotic Agents; Benzodiazepines; Clinical Trials as Topic; Clozapine; Depression; Depressive Disorder; Dibenzothiazepines; Hostility; Humans; Multicenter Studies as Topic; Olanzapine; Piperazines; Pirenzepine; Psychiatric Status Rating Scales; Quetiapine Fumarate; Risperidone; Schizophrenia; Schizophrenic Psychology; Suicide; Thiazoles; Treatment Outcome

It remains unclear whether unipolar psychotic depression should be treated with an antidepressant and an antipsychotic or with an antidepressant alone.. In a multi-center RCT, 122 patients (18-65 years) with DSM-IV-TR psychotic major depression and HAM-D-17 > or = 18 were randomized to 7 weeks imipramine (plasma-levels 200-300 microg/l), venlafaxine (375 mg/day) or venlafaxine-quetiapine (375 mg/day, 600 mg/day). Primary outcome was response on HAM-D-17. Secondary outcomes were response on CGI and remission (HAM-D-17).. Venlafaxine-quetiapine was more effective than venlafaxine with no significant differences between venlafaxine-quetiapine and imipramine, or between imipramine and venlafaxine. Secondary outcomes followed the same pattern.. That unipolar psychotic depression should be treated with a combination of an antidepressant and an antipsychotic and not with an antidepressant alone, can be considered evidence based with regard to venlafaxine-quetiapine vs. venlafaxine monotherapy. Whether this is also the case for imipramine monotherapy is likely, but cannot be concluded from the data.

Topics: Adolescent; Adult; Affective Disorders, Psychotic; Aged; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Cyclohexanols; Depressive Disorder; Dibenzothiazepines; Double-Blind Method; Drug Administration Schedule; Drug Dosage Calculations; Drug Therapy, Combination; Female; Humans; Imipramine; Male; Middle Aged; Quetiapine Fumarate; Remission Induction; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome; Venlafaxine Hydrochloride; Young Adult

To investigate the efficacy and safety of quetiapine for depressive symptoms in patients with schizophrenia.. Thirty-nine patients fulfilling DSM-IV-TR diagnostic criteria for schizophrenia and had depressive symptoms were studied in a prospective 6-week open-label design using quetiapine monotherapy. The brief psychiatric rating scale (BPRS), 17-item Hamilton depression rating scale (HAMD-17), Simpson-Angus rating scale, and the Barnes Akathisia rating scale (BARS) were used to assess patients at baseline, week 1, 2, 4, and 6.. Thirty patients (76.9%) completed this study. The dose of quetiapine at endpoint was 583 (+/-235 SD) mg/day. Treatment with Quetiapine was associated with significantly reduced depressive symptoms (HAMD-17 total score and BPRS depression/anxiety subscale) from the first week of treatment. Changes of mean score from baseline to endpoint were 7.8 +/- 6.2 for HAMD-17 total score and 3.4 +/- 3.6 for BPRS depression/anxiety subscale (LOCF, n = 39, p < 0.001). Quetiapine was well tolerated, with minimal extrapyramidal symptoms and non-significant increase in body weight (mean increase of 0.8 kg).. While the interpretation of findings from the open-label design of this study warrants appropriate caution, the results suggest that quetiapine may be an effective and tolerable treatment for depression in patients with schizophrenia.

Topics: Adult; Antipsychotic Agents; Basal Ganglia Diseases; Body Weight; Depressive Disorder; Dibenzothiazepines; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Male; Prospective Studies; Psychiatric Status Rating Scales; Psychometrics; Quetiapine Fumarate; Schizophrenia; Schizophrenic Psychology

To investigate the adjunctive effects of quetiapine on overall treatment response and on specific symptoms in agitated depression.. Twenty-one patients suffering from an acute agitated major depressive episode were enrolled in the quetiapine/venlafaxine study group (QUET) in the context of a 6-week open-label, flexible dose, non-randomized case-control study. Eighteen matched depressed patients treated with antidepressants only served as controls (CON). Clinical assessment was carried out by the use of Hamilton Rating Scale for Depression (HAM-D) 21 scale.. Both groups had high HAM-D scores at baseline (27.6 vs. 27.5; p = 0.94). The QUET group displayed a significantly larger HAM-D decrease already after 1 week of treatment (p = 0.026, d = 0.77). This group difference increased slightly until week 6 (p = 0.005, d = 1.0). The remission rate in the QUET group (70%) was almost double that of the CON group (38.5%), p = 0.022. The overall effect originated from various HAM-D items indicating agitation, sleep problems and anxiety.. Adjunctive quetiapine treatment in agitated depression showed faster and greater response leading to higher remission rates compared with antidepressants alone. Overall clinical improvement was specifically related to single aspects of psychopathology indicating that quetiapine develops its positive effects through a variety of psychopharmacological properties.

Topics: Adult; Aged; Analysis of Variance; Antidepressive Agents; Antipsychotic Agents; Case-Control Studies; Depressive Disorder; Dibenzothiazepines; Female; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Quetiapine Fumarate; Young Adult

The depressive symptoms of bipolar disorder impact health-related quality of life, quality of sleep and functioning. The BOLDER I and II trials demonstrated that quetiapine significantly improves depressive symptoms in patients with acute bipolar depression. Post-hoc analysis of the BOLDER I and II data permits a detailed investigation of the effects of quetiapine on these other measures in this patient population.. Secondary analysis was performed on data from BOLDER I and II, which were two 8-week, double-blind, randomized, placebo-controlled studies of quetiapine at fixed doses (300 or 600 mg/day) in a total of 1051 patients with acute depressive episodes of bipolar I or II disorder. Measures included the Short-Form Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q SF) in BOLDER I and II, the Pittsburgh Sleep Quality Index (PSQI) in BOLDER I, and the Sheehan Disability Scale (SDS) in BOLDER II. Analyses of Q-LES-Q SF score changes were based on data from the combined BOLDER I and II populations, and analyses of PSQI and SDS score changes were based on BOLDER I and BOLDER II populations, respectively.. Assessments at day 57 by mixed-model repeated measures analysis demonstrated that quetiapine relative to placebo provided significant or numerical improvements in rating scale score on the Q-LES-Q SF (10.89 with 300 mg/day and 12.14 with 600 mg/day vs. 7.79 with placebo; p<0.001 for each quetiapine dose), PSQI (-5.34 and -6.00 vs. -3.35; p<0.001, each dose), and SDS (-7.78 and -8.25 vs. -6.49; p=0.156 and 0.054, respectively). Effect sizes at day 57 with quetiapine 300 and 600 mg/day, respectively, were 0.34 and 0.46 for Q-LES-Q SF, 0.59 and 0.79 for PSQI, and 0.17 and 0.23 for SDS. Improvements were evident at first post-baseline assessment on day 29 and were consistent over the majority of rating scale domains. Quetiapine was generally well tolerated and most adverse events were of mild to moderate intensity.. Quetiapine monotherapy is effective in improving impairment in important aspects of life that accompany improvements in depressive symptoms in patients with acute bipolar depression.

Topics: Acute Disease; Adolescent; Adult; Aged; Ambulatory Care; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Double-Blind Method; Drug Administration Schedule; Female; Health Status; Humans; Male; Middle Aged; Personal Satisfaction; Placebos; Psychiatric Status Rating Scales; Quality of Life; Quetiapine Fumarate; Severity of Illness Index; Sleep; Surveys and Questionnaires; Treatment Outcome

The prevalence of and morbidity associated with treatment-resistant depression has motivated the exploration of treatment alternatives. In this study, quetiapine was compared with lithium in the augmentation of treatment-resistant depression.. Open-label, comparative study in 20 patients with major depression who had failed to respond after 4 weeks of treatment with an antidepressant at the maximal recommended dose. Patients were randomised to either lithium or quetiapine in addition to the maximally dosed antidepressant and any other concurrent medications. Lithium was initiated at 600 mg/day; quetiapine was titrated to 400 mg by day 7.. Depression, measured by the Hamilton Depression Rating Scale (HAM-D), significantly improved from baseline in both quetiapine (F(1,90) = 25.11, p < 0.0001) and lithium (F(1,90) = 34.54, p < 0.0001). The difference in improvement between the two groups began at day 14 and was seen at all timepoints thereafter (p < 0.05), with the quetiapine group showing greater improvement than the lithium group. In the Montgomery-Asberg Depression Rating Scale (MADRS) analysis, the difference between the quetiapine and lithium group was significant from day 28 onwards (p < 0.05), with subjects improving more in the quetiapine group than the lithium group. The treatment by week interaction showed a significant difference overall between the two groups (p < 0.0001). The severity of psychomotor retardation showed a significant decrease in the Widlocher Psychomotor Retardation Scale scores in the quetiapine (p < 0.0001) and lithium (p < 0.0001) groups.. In this pilot study, quetiapine was an effective augmenting agent in treatment-resistant depression.

Topics: Adult; Aged; Antidepressive Agents; Depressive Disorder; Dibenzothiazepines; Drug Resistance; Drug Synergism; Drug Therapy, Combination; Fatigue; Female; Humans; Lithium Compounds; Male; Middle Aged; Nausea; Pilot Projects; Psychomotor Performance; Quetiapine Fumarate; Serotonin Receptor Agonists; Severity of Illness Index; Treatment Outcome; Tremor

Bipolar disorder (BD) is a disabling and often chronic condition. Patients with BD suffer from depression at least one-third of the time, but they do not always respond well to conventional mood stabilizers. Attempts to treat them with antidepressants can provoke a switch to mania or increased cycling. Our open-label trial aimed to assess the long-term response of patients with bipolar depression to the addition of quetiapine to their usual treatment. Our study also sought to assess the safety and tolerability of quetiapine in patients with BD.. To meet inclusion criteria for the study, patients had a DSM-IV diagnosis of type I or II BD, were aged 18 years and older, currently suffered from depression with a score of > 18 on the Hamilton Depression Rating Scale (HDRS), and had no change in antidepressant use for at least 3 weeks prior to the study. We added quetiapine to patients' medication and attempted to increase the dosage to at least 400 mg daily. Outcome was measured at baseline and once monthly for 12 months on the HDRS, the Young Mania Rating Scale, the Clinical Global Impression Scale (CGI), and the Abnormal Involuntary Movement Scale.. There were 19 patients enrolled in the study (6 men and 13 women), 2 of whom dropped out because they could not tolerate the drug. Seventeen completed at least 2 assessments, and 7 patients completed the full 12-month trial. Data for the 17 patients (that is, last observation carried forward) at 12 months shows HDRS scores reduced from 27.2 to 12.1 and CGI scores reduced from 4.7 to 2.6.. Quetiapine seems to be helpful to and relatively well tolerated by patients with bipolar depression when it is added to their usual treatment. There is, however, a need for controlled trials.

Topics: Adult; Aged; Antipsychotic Agents; Bipolar Disorder; Chronic Disease; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Drug Administration Schedule; Dyskinesia, Drug-Induced; Female; Humans; Male; Middle Aged; Periodicity; Prospective Studies; Quetiapine Fumarate; Surveys and Questionnaires; Treatment Outcome

This analysis of data from the open-label extension (OLE) phases of three randomized clinical trials of quetiapine in patients with schizophrenia (n=415) was undertaken to investigate whether the initial improvements in anxiety and depressive symptoms were maintained during long-term treatment. The mean (95% confidence interval [CI]) change from the acute phase baseline in the Factor I score of the Brief Psychiatric Rating Scale (BPRS), which includes somatic concern, anxiety, guilt feelings, and depression, was calculated at the OLE baseline and at various time points up to 156 weeks. After 6 weeks of treatment with quetiapine during the acute phase, the mean (95% CI) change in the BPRS Factor I score was -1.13 (-1.23, -1.04) and after 156 weeks, it was -1.33 (-1.78, -0.87). Therefore, the efficacy of quetiapine for the treatment of anxiety and depressive symptoms is maintained in long-term treatment.

Topics: Adult; Aged; Antipsychotic Agents; Anxiety Disorders; Brief Psychiatric Rating Scale; Depressive Disorder; Dibenzothiazepines; Double-Blind Method; Drug Administration Schedule; Female; Humans; Long-Term Care; Male; Middle Aged; Patient Compliance; Quetiapine Fumarate; Schizophrenia; Schizophrenic Psychology; Treatment Outcome

While atypical antipsychotics appear to be effective in reducing depressive symptoms in the acute phase of schizophrenia, little is known about their efficacy in patients with ongoing symptoms. The present study assessed whether quetiapine (Seroquel) is more effective than haloperidol in treating depressive symptoms in patients with persistent positive symptoms, and investigated whether this effect is independent, or secondary to, reductions in other symptoms such as positive, negative or extrapyramidal symptoms. Patients with schizophrenia and a history of partial refractoriness to conventional antipsychotics who had not responded to 4 weeks of fluphenazine treatment (20 mg/day) were randomized to receive either quetiapine (600 mg/day) or haloperidol (20 mg/day) for a further 8 weeks. Change in the Positive and Negative Syndrome Scale depression factor score from baseline to endpoint was calculated and path analyses were performed on data from 269 patients. Quetiapine produced a greater reduction in depressive scores than haloperidol (-1.60 versus -0.54; p = 0.006). The path analyses indicated that this was a direct effect on depressive symptoms. These findings extend the evidence for an antidepressant effect for the novel antipsychotics in schizophrenia, and suggest that this is not limited to acutely psychotic patients.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Double-Blind Method; Female; Haloperidol; Humans; Male; Quetiapine Fumarate; Schizophrenia; Treatment Outcome

This post-authorization safety study (PASS) was a commitment to the European Medicines Agency.. This PASS investigated quetiapine as antidepressant treatment in Swedish registers with regard to the risk for all-cause mortality, self-harm and suicide, acute myocardial infarction, stroke, diabetes mellitus, extrapyramidal disorders, and somnolence.. Users of quetiapine and antidepressants (2011‒2014) who had changed treatment in the past year were included. Conditional logistic regression models were used to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for each outcome in nested case-control studies for quetiapine as combination therapy and monotherapy, monotherapy with antidepressants, and no medication, versus the use of combinations of antidepressants (reference group).. Overall, 7421 quetiapine users and 281,303 antidepressant users were included. For quetiapine in combination, risks were increased for all-cause mortality [adjusted OR (aOR) 1.31, 95% CI 1.12-1.54] compared with combinations of antidepressants; however, when stratified by age, only patients ≥ 65 years of age had an increased mortality, and, in a post hoc analysis excluding patients with Parkinson's disease, no mortality increase remained. Furthermore, the risk for self-harm and suicide was increased (aOR 1.53, 95% CI 1.31-1.79), but when stratified by age, the risk increase was found only among patients aged 18-64 years. Risks were also increased for stroke among patients ≥ 65 years of age (aOR 1.47, 95% CI 1.01-2.12), for extrapyramidal disorder (aOR 6.15, 95% CI 3.57-10.58), and for somnolence (aOR 2.41, 95% CI 1.42-4.11).. Risks for all-cause mortality, self-harm and suicide, and stroke in older patients may be higher among patients treated with quetiapine and antidepressant combination therapy.

Topics: Adolescent; Adult; Aged; Antidepressive Agents; Case-Control Studies; Depressive Disorder; Female; Humans; Logistic Models; Male; Middle Aged; Quetiapine Fumarate; Retrospective Studies; Self-Injurious Behavior; Suicide; Sweden; Treatment Outcome; Young Adult

Topics: Adult; Agoraphobia; Antibodies, Monoclonal, Humanized; Antidepressive Agents; Antimanic Agents; Benzodiazepines; Bipolar Disorder; Depressive Disorder; Depressive Disorder, Major; Female; Humans; Lithium Carbonate; Male; Mental Disorders; Middle Aged; Nordazepam; Panic Disorder; Paroxetine; Psoriasis; Quetiapine Fumarate; Severity of Illness Index; Treatment Outcome; Valproic Acid

Topics: Antidepressive Agents; Depressive Disorder; Humans; Quetiapine Fumarate; Suicidal Ideation

Congenital thrombocytopenic purpura (TTP) is a rare but serious condition. We present a case of a 29-year-old woman, diagnosed with this disease in adulthood. The episode that led to diagnosis was triggered by quetiapine. She presented with neurological symptoms and laboratory findings including low platelets and elevated creatinine. Interestingly, the signs of hemolysis were very subtle. Her symptoms were relieved by withdrawal of the medicine. The diagnosis was confirmed by very low ADAMTS13 activity, lack of antibodies against ADAMTS13 and the presence of a compound heterozygous ADAMTS13 mutation. Despite prophylactic plasma infusions, the patient developed a second episode of microangiopathy, leading to an extensive cerebral infarction. It is possible that even the latter episode was triggered by drugs. We suggest that the diagnosis of TTP should be considered in patients with neurological symptoms and unexplained thrombocytopenia.

Topics: Adult; Antidepressive Agents; Depressive Disorder; Female; Humans; Phenotype; Plasma Exchange; Purpura, Thrombotic Thrombocytopenic; Quetiapine Fumarate

Topics: Antipsychotic Agents; Depressive Disorder; Electroconvulsive Therapy; Humans; Lithium Compounds; Male; Middle Aged; Penis; Quetiapine Fumarate; Self Mutilation; Suicide, Attempted

Use of second-generation antipsychotics (SGAs) for treatment of depression has increased, and patients with depression and comorbid diabetes or cardiovascular disease are more likely to use SGAs than those without these conditions. We compared SGA and non-SGA depression pharmacotherapies on the risk of diabetes hospitalization or treatment intensification in adults with depression and preexisting diabetes.. This was a retrospective cohort study of US commercially insured adults (2009-2015 Truven MarketScan Commercial Claims and Encounters Database) aged 18-64 years old with type 2 diabetes mellitus and unipolar depression previously treated with a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor. New users of SGAs versus non-SGAs, as well as specific treatments (aripiprazole, quetiapine, bupropion, mirtazapine, and tricyclic antidepressants [TCAs]) were matched on class/medication-specific high-dimensional propensity score. Cox proportional hazard models were used to compare the risk of diabetes-related hospitalization or treatment intensification.. We identified 6,625 SGA (aripiprazole = 3,461; quetiapine = 1,977; other = 1,187) and 23,921 non-SGA patients for inclusion (bupropion = 15,511; mirtazapine = 1,837; TCAs = 5,989; other = 584) with a mean age of 51 years. In the matched cohort, the rate of diabetes-related hospitalization or drug intensification was 47.9 per 100 person-years in the SGA group and 43.5 per 100 person-years in the non-SGA group (adjusted hazard ratio [aHR] = 1.03; 95% CI, 0.96-1.11). When comparing treatment subgroups, the risk of events was lower for bupropion versus TCAs (aHR = 0.85; 95% CI, 0.76-0.98), quetiapine versus mirtazapine (aHR = 0.82; 95% CI, 0.67-0.99), and quetiapine versus TCAs (aHR = 0.84; 95% CI, 0.72-0.98). For other comparisons, differences were small and not statistically significant.. While drug-specific effects on risk of diabetes hospitalization or treatment intensification most likely guide clinical decision making, we observed only modest differences in risk. The overall impact of SGAs on diabetes control depends not only on direct effects on glucose metabolism but also on effectiveness of depression symptom relief. Future studies evaluating other diabetes outcomes (glycosylated hemoglobin, diabetes complications) are needed.

Topics: Adolescent; Adult; Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Bupropion; Comorbidity; Depressive Disorder; Diabetes Mellitus, Type 2; Female; Hospitalization; Humans; Male; Mianserin; Middle Aged; Mirtazapine; Proportional Hazards Models; Quetiapine Fumarate; Retrospective Studies; Young Adult

The objective of this study was to evaluate trends in prescribing of the second-generation antipsychotic medication quetiapine to adults in the province of Alberta from 2008 to 2013 through examination of dispensed prescriptions, and diagnoses associated with users of quetiapine in 2013.. We analysed administrative data from Alberta Health; the Alberta Pharmaceutical Information Network (PIN) Dispenses health data set, the Practitioner Payments (Fee-For-Service claims) health data set and the Population Registry health data set. These data sets allowed us to identify discrete quetiapine recipients for each calendar year from 2008 to 2013. To evaluate diagnoses associated with users of quetiapine, we evaluated diagnostic codes used by physicians in billings claims in 2013.. Quetiapine use increased over the 6-year time period studied. In 2008, there were 16,087 unique quetiapine recipients in Alberta (7.2 per 1000). By 2013, there were 35,314 unique quetiapine recipients (13.3 per 1000). Use by women was higher than men at all time points. Depression was most common diagnosis associated with quetiapine recipients, which was present in 56% of users of quetiapine. Other common diagnoses associated with quetiapine use included neurotic disorders, bipolar disorder and sleep disturbances.. The current study of quetiapine use in the province of Alberta provides confirmatory data of the increasing use of quetiapine for the treatment of depression and anxiety disorders. Safe and rational prescribing practices must be encouraged in light of the modest advantages of quetiapine over no treatment as an adjunctive treatment of major depression, and the known harms of this medication.

Topics: Adult; Alberta; Antipsychotic Agents; Anxiety Disorders; Depressive Disorder; Drug Prescriptions; Female; Humans; Male; Middle Aged; Quetiapine Fumarate; Sex Distribution; Young Adult

Spinocerebellar ataxia (SCA) is a hereditary disease characterized by central nervous system-related motor dysfunctions. Sleep disorders and frequent non-motor manifestations are commonly comorbid with SCA. To elucidate this relationship, we present three cases in a family that included multiple SCA type 2 patients with various sleep disorders. Complete physical examination, and genetic and imaging studies were performed. Anti-parkinsonism medications were prescribed after neurological examination. Clonazepam and/or quetiapine were administered for sleep disorders but failed to resolve insomnia and excessive daytime sleepiness (EDS). Based on DSM-5 criteria, all cases were diagnosed with depression. After treatment with serotonin-norepinephrine reuptake inhibitors and noradrenergic and specific serotonergic antidepressants, symptoms of insomnia and EDS, which are strongly associated with depression in SCA type 2 patients, improved significantly. It is crucial to recognize insomnia and EDS in neurodegenerative diseases, not only for earlier diagnosis, but also to improve quality of life.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Clonazepam; Depressive Disorder; Disorders of Excessive Somnolence; Family; Female; GABA Modulators; Humans; Male; Middle Aged; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors; Sleep Initiation and Maintenance Disorders; Spinocerebellar Ataxias; Treatment Outcome

Topics: Anthropology, Cultural; Antipsychotic Agents; Aripiprazole; Clonazepam; Depressive Disorder; GABA Modulators; Humans; Inappropriate Prescribing; Quetiapine Fumarate; Sleep

Topics: Analgesics, Opioid; Antidepressive Agents, Second-Generation; Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Citalopram; Depressive Disorder; Drug Interactions; Humans; Lithium Compounds; Low Back Pain; Male; Middle Aged; Quetiapine Fumarate; Sulfates; Tramadol

In 2004, the American Diabetes Association (ADA) released treatment guidelines recommending metabolic screening for children and adolescents before and after initiation of second-generation antipsychotics. Prior studies showed that the guidelines coincided with a small increase in glucose testing of children and adults but had limited follow-up. This study sought to evaluate changes in metabolic screening of children initiating second-generation antipsychotics around the time of the 2004 guidelines and in the following eight years.. Study patients (N=52,407) were identified in a large nationwide commercial insurance claims database for the period January 1, 2003, through December 31, 2011. The study population was a cohort of nondiabetic new users of second-generation antipsychotics who were ages 5-18. Glucose and HbA1c tests completed before and after second-generation antipsychotic initiation were identified with Current Procedural Terminology-4 codes. Metabolic screening was also examined by second-generation antipsychotic agent prescribed and psychiatric diagnosis.. The proportion of patients receiving a glucose test preinitiation increased from 17.9% in 2003 to 18.9% in 2004, and testing postinitiation increased from 14.7% to 16.6% in the same period. The slight increase in glucose testing was not sustained; the proportion tested dropped in the following years before rising again in 2008. Glucose screening was most common for patients taking aripiprazole. Patients with a diagnosis of hyperkinetic disorder were less likely to be tested. HbA1c testing was less frequent but had a similar usage pattern.. The small improvement in metabolic screening immediately after the 2004 ADA guidelines were issued was not sustained. Overall, metabolic screening rates remained suboptimal throughout the study period.

Topics: Adolescent; Affective Disorders, Psychotic; Antipsychotic Agents; Anxiety Disorders; Aripiprazole; Benzodiazepines; Blood Glucose; Child; Child, Preschool; Cohort Studies; Conduct Disorder; Databases, Factual; Depressive Disorder; Diabetes Mellitus; Female; Glycated Hemoglobin; Guideline Adherence; Humans; Hyperkinesis; Male; Mass Screening; Mental Disorders; Olanzapine; Piperazines; Practice Guidelines as Topic; Practice Patterns, Physicians'; Psychotic Disorders; Quetiapine Fumarate; Retrospective Studies; Risperidone; Thiazoles

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Female; Humans; Psychotic Disorders; Quetiapine Fumarate; Restless Legs Syndrome

A 60-year-old woman reported horizontal "shimmering" movement while reading crossword puzzles when using fluvoxamine, bupropion, quetiapine, lithium, and levothyroxine. This visual disturbance, likely oscillopsia, started after the fluvoxamine was added and waned as the fluvoxamine was tapered, disappearing after the drug was discontinued. Genetic testing to explore how the patient metabolizes these medications combined with YouScript® interaction analysis suggest that she may have had abnormally high plasma concentrations of fluvoxamine during this time. Oscillopsia may be a novel dose-dependent side effect of fluvoxamine. Genetic testing combined with YouScript has the potential to discover novel drug side effects, elucidate drug interactions and guide future prescribing decisions.

Topics: Antidepressive Agents, Second-Generation; Antipsychotic Agents; Bupropion; Depressive Disorder; Dopamine Uptake Inhibitors; Drug Interactions; Female; Fluvoxamine; Humans; Middle Aged; Ocular Motility Disorders; Precision Medicine; Quetiapine Fumarate

Topics: Alcoholism; Benzodiazepines; Clonazepam; Depressive Disorder; Dibenzothiazepines; Disulfiram; Female; Fluoxetine; Foreign Bodies; Hallucinations; Humans; Middle Aged; Movement Disorders; Olanzapine; Pharynx; Quetiapine Fumarate; Tetrabenazine; Tongue Habits

Topics: Adult; Aged; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Female; Humans; Male; Middle Aged; Quetiapine Fumarate; Sleep Initiation and Maintenance Disorders; Somnambulism

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Duloxetine Hydrochloride; Humans; Male; Quetiapine Fumarate; Thiophenes; Urinary Catheterization; Urinary Retention

Quetiapine, an atypical antipsychotic, may have efficacy as augmentation therapy in treatment resistant depression (TRD), but evidence is limited and the underlying mechanism remains poorly understood. Therefore, this study was aimed to investigate whether and how quetiapine can be served as an augmentation agent in fluoxetine treatment resistant depressive rats induced by chronic unpredictable mild stress (CUMS). In this study, the effects of CUMS regimen and antidepressant treatment were assessed by behavioral tests and hippocampal neurogenesis. Approximately 20-30% of depressive rats respond poorly to fluoxetine treatment. In their hippocampus, a significant decrease of neurogenesis was also observed. However, quetiapine add-on therapy significantly improved the depressive behaviors and increased the number of the newborn neurons in the hippocampus of fluoxetine treatment resistant depressive rats. Thus, our results suggest that quetiapine may be used as an augmentation agent in the treatment resistant depression partly mediated by increasing the number of newborn neurons in the hippocampus.

Topics: Animals; Antidepressive Agents, Second-Generation; Antimetabolites; Antipsychotic Agents; Bromodeoxyuridine; Cell Count; Cell Proliferation; Depressive Disorder; Dibenzothiazepines; Drug Resistance; Drug Therapy, Combination; Eating; Environment; Fluoxetine; Hippocampus; Immunohistochemistry; Male; Neurogenesis; Quetiapine Fumarate; Rats; Rats, Sprague-Dawley; Stress, Psychological; Sucrose; Swimming; Tissue Fixation

A 24-year-old man with bipolar disorder who was started on quetiapine as an adjunct to valproate (mood stabiliser) after a depressive episode switched to a manic episode while on the drug. The manic episode resolved following the withdrawal of quetiapine. This case illustrates the rare possibility of quetiapine emergent manic episode which a clinician needs to be aware of in the context of the management of bipolar disorders.

Topics: Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Diagnosis, Differential; Dibenzothiazepines; Humans; Male; Quetiapine Fumarate; Treatment Outcome; Young Adult

Depressive mood in adolescents with bipolar disorder (BDd) is associated with significant morbidity and mortality, but we have limited information about neural correlates of depression and treatment response in BDd. Ten adolescents with BDd (8 females, mean age = 15.6 ± 0.9) completed two (fearful and happy) face gender labeling fMRI experiments at baseline and after 6-weeks of open treatment. Whole-brain analysis was used at baseline to compare their neural activity with those of 10 age and sex-matched healthy controls (HC). For comparisons of the neural activity at baseline and after treatment of youth with BDd, region of interest analysis for dorsal/ventral prefrontal, anterior cingulate, and amygdala activity, and significant regions identified by wholebrain analysis between BDd and HC were analyzed. There was significant improvement in depression scores (mean percentage change on the Child Depression Rating Scale-Revised 57 % ± 28). Neural activity after treatment was decreased in left occipital cortex in the intense fearful experiment, but increased in left insula, left cerebellum, and right ventrolateral prefrontal cortex in the intense happy experiment. Greater improvement in depression was associated with baseline higher activity in ventral ACC to mild happy faces. Study sample size was relatively small for subgroup analysis and consisted of mainly female adolescents that were predominantly on psychotropic medications during scanning. Our results of reduced negative emotion processing versus increased positive emotion processing after treatment of depression (improvement of cognitive bias to negative and away from positive) are consistent with the improvement of depression according to Beck's cognitive theory.

Topics: Adolescent; Anticonvulsants; Antidepressive Agents; Antipsychotic Agents; Aripiprazole; Bipolar Disorder; Brain; Citalopram; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Emotions; Facial Expression; Female; Humans; Lamotrigine; Magnetic Resonance Imaging; Male; Piperazines; Psychotropic Drugs; Quetiapine Fumarate; Quinolones; Sertraline; Triazines; Valproic Acid

Quetiapine is an atypical antipsychotic licensed for the treatment of schizophrenia and bipolar disorder and as an adjunctive for patients with unipolar depression. Case reports suggest a potential for drug abuse, especially among individuals with prior or current abuse of other substances.

Topics: Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Humans; Quetiapine Fumarate; Schizophrenia; Substance-Related Disorders

Akathisia is a syndrome characterized by the unpleasant sensation of "inner" restlessness that manifests itself in the inability of sitting still or not moving. Many types of medicaments can cause akathisia as an adverse event of their use and they include: antipsychotics, antidepressants, antiemetics, antihistamines, and psychoactive substances. We will present the case of a 50 year old patient, treated on two occasions for psychotic depression. During the second hospitalization it is possible that antipsychotic treatment combined with an antidepressant caused akathisia or there were symptoms of agitated depression and akathisia present at the same time, which is very difficult to determine in everyday clinical practice. We can conclude that in this case, as in many others, akathisia as a possible adverse effect of psychopharmacs was very hard to identify. Therefore, it is necessary to have akathisia in mind when using certain medicaments, especially when combining several that use the same enzymatic system and consequently raise levels of at least one of them.

Topics: Affective Disorders, Psychotic; Akathisia, Drug-Induced; Anticonvulsants; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Benzodiazepines; Depressive Disorder; Diagnosis, Differential; Diagnostic Errors; Dibenzothiazepines; Drug Interactions; Drug Therapy, Combination; Fluvoxamine; Humans; Male; Middle Aged; Olanzapine; Psychomotor Agitation; Quetiapine Fumarate; Valproic Acid

We conducted an electronic chart review of a sample of all people attending secondary mental health care, in the county of Lanarkshire, Scotland, who were commenced on quetiapine for the following mood disorders: non-psychotic depression (n = 171), psychotic depression (n = 39), bipolar mania (n = 24), bipolar depression (n = 38) and bipolar mixed states (n = 31), between 2002 and 2007. We retrospectively assigned severity and improvement Clinical Global Impression (CGI) scores to measure effectiveness. Quetiapine was co-prescribed with antidepressants in 75-97% of depressive disorders. Commencing quetiapine was associated with clinical improvement in >64% of all patients, median doses (200-400 mg/day). For all depressive subtypes (non-psychotic, psychotic and bipolar) quetiapine was associated with improvement in 69% of patients. Across CGI measures, bipolar mania patients had the best outcome (89% improved). In bipolar mania, higher maximum doses were associated with greater improvement and 45% were continued on antidepressants. The results should be interpreted with caution due to the observational nature of the study and findings may not be attributed to the effects of quetiapine alone. Quetiapine was used mainly as an adjunct to other antidepressant and mood stabilising agents. The pharmacological profile of quetiapine suggests its properties extend beyond antipsychotic action, to antidepressant, anxiolytic and mood stabilising effects.

Topics: Adult; Affect; Antidepressive Agents; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Female; Humans; Male; Mental Health Services; Middle Aged; Psychiatric Status Rating Scales; Quetiapine Fumarate; Retrospective Studies; Scotland; Severity of Illness Index; Time Factors; Treatment Outcome

Investigation of heroin addict patients in post-abstinent state revealed that low mood, anxiety, tension and guilt feeling increased sensitivity toward pain, which mostly experienced as algetic, coenestetick and hypochondriacal sensations. Algetic symptoms highly correlated with psychopathology. Efficient treatment of psychopathological symptoms decreased pain. It is concluded that Atypical antipsychotic quetiapin monotherapy could be used for treating such conditions.

Topics: Adult; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Female; Heroin Dependence; Humans; Male; Pain; Pain Perception; Quetiapine Fumarate

The aim of the current study was to evaluate quetiapine doses used across diagnosis categories in a sample of psychiatric inpatients.. Discharge letters of all adult inpatients who had received quetiapine between 1999 and 2005 were retrospectively reviewed. Logistic regressions were carried-out to assess links between quetiapine discharge dosage (> or =800 mg/day vs. <800 mg/day), diagnostic categories, substance abuse or dependence, benzodiazepine discharge doses, age and sex.. The data of 231 patients were included. Five hundred and for discharge documents were analyzed: 113 for psychotic disorders, 190 for personality disorders, 134 for bipolar and schizoaffective bipolar disorders, 29 for unipolar depression or anxiety disorders, and 35 for mental retardation. Considering psychotic disorders as a reference group, patients with personality disorders were statistically significantly less likely to be in the high quetiapine dosage group at discharge (P = 0.007, OR = 0.1 and CI [0.03; 0.6]).. Quetiapine seems to be used in a variety of clinical situations, with a wide range of doses and a lower dosage in patients treated for personality disorders.

Topics: Adult; Antipsychotic Agents; Anxiety Disorders; Benzodiazepines; Bipolar Disorder; Cross-Sectional Studies; Depressive Disorder; Dibenzothiazepines; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Intellectual Disability; Male; Mental Disorders; Middle Aged; Patient Discharge; Patient Readmission; Personality Disorders; Psychotic Disorders; Quetiapine Fumarate; Retrospective Studies

Topics: Adult; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Cyclohexanols; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Female; Hallucinations; Humans; Psychiatric Status Rating Scales; Quetiapine Fumarate; Schizophrenia, Paranoid; Syndrome; Venlafaxine Hydrochloride

Mycophenolate mofetil (MMF) is increasingly used as an immunosuppressant for organ transplantation and for treatment of autoimmune diseases. As yet, the experience with acute overdose of MMF in humans is limited. Herein we have reported a 40-year-old female kidney recipient with moderate leukopenia and lack of gastrointestinal toxicity following ingestion of 25 g MMF, which was confirmed by serum drug levels. We treated the patient with charcoal decontamination and oral cholestyramine. She recovered completely without sequelae.

Topics: Adult; Antidepressive Agents; Benzodiazepines; Charcoal; Cholestyramine Resin; Depressive Disorder; Diazepam; Dibenzothiazepines; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Leukopenia; Mycophenolic Acid; Quetiapine Fumarate; Renal Dialysis; Valproic Acid

Quetiapine is an atypical antipsychotic drug that is also US FDA approved for treating bipolar depression, albeit by an unknown mechanism. To discover the potential mechanism for this apparently unique action, we screened quetiapine, its metabolite N-Desalkylquetiapine, and dibenzo[b,f][1,4]thiazepine-11(10-H)-one (DBTO) against a large panel of G-protein-coupled receptors, ion channels, and neurotransmitter transporters. DBTO was inactive at all tested molecular targets. N-Desalkylquetiapine had a high affinity (3.4 nM) for the histamine H(1) receptor and moderate affinities (10-100 nM) for the norepinephrine reuptake transporter (NET), the serotonin 5-HT(1A), 5-HT(1E), 5-HT(2A), 5-HT(2B), 5-HT(7) receptors, the alpha(1B)-adrenergic receptor, and the M(1), M(3), and M(5) muscarinic receptors. The compound had low affinities (100-1000 nM) for the 5-HT(1D), 5-HT(2C), 5-HT(3), 5-HT(5), 5-HT(6), alpha(1A), alpha(2A), alpha(2B), alpha(2C), H(2), M(2), M(4), and dopamine D(1), D(2), D(3), and D(4) receptors. N-Desalkylquetiapine potently inhibited human NE transporter with a K(i) of 12 nM, about 100-fold more potent than quetiapine itself. N-Desalkylquetiapine was also 10-fold more potent and more efficacious than quetiapine at the 5-HT(1A) receptor. N-Desalkylquetiapine was an antagonist at 5-HT(2A), 5-HT(2B), 5-HT(2C), alpha(1A), alpha(1D), alpha(2A), alpha(2C), H(1), M(1), M(3), and M(5) receptors. In the mouse tail suspension test, N-Desalkylquetiapine displayed potent antidepressant-like activity in VMAT2 heterozygous mice at doses as low as 0.1 mg/kg. These data strongly suggest that the antidepressant activity of quetiapine is mediated, at least in part, by its metabolite N-Desalkylquetiapine through NET inhibition and partial 5-HT(1A) agonism. Possible contributions of this metabolite to the side effects of quetiapine are discussed.

Topics: Adrenergic Uptake Inhibitors; Animals; Antidepressive Agents; Antipsychotic Agents; Brain Chemistry; Cell Line; CHO Cells; Cricetinae; Cricetulus; Depressive Disorder; Dibenzothiazepines; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Female; Humans; Male; Mice; Mice, Inbred C57BL; Mice, Knockout; Quetiapine Fumarate; Rats; Receptor, Serotonin, 5-HT1A; Serotonin 5-HT1 Receptor Agonists; Serotonin Receptor Agonists; Vesicular Monoamine Transport Proteins

Topics: Adult; Angiography; Antipsychotic Agents; Cardiomyopathy, Dilated; Depressive Disorder; Diagnosis, Differential; Dibenzothiazepines; Echocardiography; Fatal Outcome; Female; Humans; Quetiapine Fumarate; Radiography, Thoracic; Tomography, X-Ray Computed

Topics: Aged; Alzheimer Disease; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Delirium; Depressive Disorder; Diagnosis, Differential; Dibenzothiazepines; Hallucinations; Humans; Male; Olanzapine; Oxazepam; Psychotic Disorders; Quetiapine Fumarate; Tachycardia

Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is an uncommon complication of treatment with centrally acting drugs including selective serotonin reuptake inhibitors (SSRIs) and antipsychotic medications. Antipsychotics are commonly used for the treatment of behavioral and psychiatric symptoms in elderly patients with dementia, and the use of those agents is increasing. Here, we report an elderly man who developed hyponatremia after treatment with medications for depression and agitation.

Topics: Aged; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Quetiapine Fumarate

Topics: Adult; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Drug Resistance; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors; Sertraline

Clinical studies show better response rates of patients with depression and schizophrenia to combinations of atypical antipsychotics and antidepressants, compared to responses to either type of drugs alone. Animal studies demonstrate that some antipsychotics and antidepressants increase neurogenesis and BDNF expression in the hippocampus, which is reduced in volume in patients with depression or schizophrenia. We hypothesized that the better therapeutic effects of combined treatment seen in schizophrenia and depression patients are related to the additive or synergistic effects of combined treatment on hippocampal neurogenesis and BDNF expression. To test this hypothesis, we investigated the effects of chronic administration of quetiapine, venlafaxine, and their combination, on hippocampal cell proliferation and BDNF expression in rats, when subjected to chronic restraint stress (CRS) during the last 2 weeks of a 3-week drug administration period. We found (1) CRS decreased hippocampal cell proliferation and BDNF expression; (2) chronic administration of quetiapine or venlafaxine dose-dependently prevented these decreases in hippocampal cell proliferation and BDNF expression caused by CRS (6 h/day for 14 days); (3) the combination of lower doses of quetiapine (5 mg/kg) and venlafaxine (2.5 mg/kg) increased hippocampal cell proliferation and prevented BDNF decrease in stressed rats, whereas each of the drugs exerted mild or no effects; (4) individual higher doses of quetiapine (10 mg/kg) or venlafaxine (5 mg/kg) exerted effects comparable to those produced by their combination. These results support our hypothesis and can lead to future studies to develop new therapeutic approaches for treatment-resistant depression and the negative symptoms of schizophrenia.

Topics: Animals; Antipsychotic Agents; Brain-Derived Neurotrophic Factor; Cell Proliferation; Chronic Disease; Cyclohexanols; Depressive Disorder; Dibenzothiazepines; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Synergism; Drug Therapy, Combination; Hippocampus; Neuronal Plasticity; Neurons; Quetiapine Fumarate; Rats; Restraint, Physical; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Stem Cells; Stress, Psychological; Venlafaxine Hydrochloride

Topics: Adult; Affective Disorders, Psychotic; Antipsychotic Agents; Breast Feeding; Depression, Postpartum; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Female; Fluvoxamine; Humans; Pregnancy; Pregnancy Complications; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors

Quetiapine fumarate (Seroquel) is a dibenzothiazepine psychotropic agent that was introduced in 1997 for treating psychoses. Quetiapine is being found with increasing frequency in postmortem cases in Virginia. We report the postmortem results and histories of 20 quetiapine cases from the Office of the Chief Medical Examiner in Virginia covering the period 1999 through 2004. Quetiapine was extracted from blood using a basic drug solid-phase extraction (SPE) and identified by full scan electron impact gas chromatography-mass spectrometry (GC-MS). Quetiapine quantification was accomplished by forming the trimethylsilyl derivative with bis(trimethylsilyl)trifluoracetamide/trimethylchlorosilane and using selected ion monitoring GC-MS. The quetiapine trimethylsilyl derivative ions acquired were m/z 210, 239, and 322. Methapyrilene was the internal standard, and ions m/z 97 and 58 were monitored. The method was linear from 0.1 to 5.0 mg/L with a limit of quantitation of 0.1 mg/L. The quetiapine mean and range of concentrations found in each tissue are as follows: peripheral blood, 7.7 mg/L (0.14-37 mg/L, n = 17); heart blood, 23.63 mg/L (0.53-76 mg/L, n = 4); liver, 91 mg/Kg (1.1-510 mg/Kg, n = 19); bile, 44 mg/L (6.0-96 mg/L, n = 4); urine, 15 mg/L (1.9-37 mg/L, n = 8); gastric, 897 mg total (3.5-3960 mg, n = 7); and vitreous, 1.4 mg/L (0.2-3.2 mg/L, n = 5). The average of all blood concentrations in 18 cases in which quetiapine contributed to the cause of death was 7.95 mg/L (0.4-76 mg/L). The manner of death in 13 of those cases was suicide, two were undetermined, and three were accidents. In two cases in which quetiapine was an incidental finding, the blood concentrations were 0.14 and 1.0 mg/L. Quetiapine and other toxicological findings are presented with the cause and manner of death to assist in interpreting future quetiapine findings in postmortem samples.

Topics: Adolescent; Adult; Antipsychotic Agents; Autopsy; Bile; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Drug Overdose; Female; Gas Chromatography-Mass Spectrometry; Gastric Juice; Humans; Liver; Male; Middle Aged; Quetiapine Fumarate; Suicide; Tissue Distribution; Virginia

Priapism is a "persistent erection not accompanied by sexual desire or stimulation, usually lasting more than six hours and typically involving only the corpora cavernosa." Here we report on a gay male patient from our HIV/AIDS mental health clinic who developed serious priapism on quetiapine and recreational amphetamine. Gay men are at high risk for amphetamine use, and as such, this potential association between priapism, quetiapine, and amphetamine use should be considered in making prescription decisions with these patients.

Topics: Amphetamine; Amphetamine-Related Disorders; Antipsychotic Agents; Comorbidity; Depressive Disorder; Dibenzothiazepines; Drug Interactions; Drug Therapy, Combination; HIV Seropositivity; Homosexuality, Male; Humans; Male; Mianserin; Middle Aged; Mirtazapine; Priapism; Psychotic Disorders; Quetiapine Fumarate

In this case report we describe a patient who suffered brainstem bleeding mainly in the pons and mesencephalon leading to locked-in syndrome. During rehabilitation she suffered psychotic symptoms of threatening character. Due to location of the lesion and the coincidental appearance of the bleeding, we diagnosed an organic psychosis. After treatment with the atypical neuroleptic drug Quetiapine, the symptoms decreased, facilitating the patient's rehabilitation course.

Topics: Antidepressive Agents, Tricyclic; Antipsychotic Agents; Brain Stem; Cerebral Hemorrhage; Delusions; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Female; Humans; Hypertension; Mianserin; Middle Aged; Mirtazapine; Neurologic Examination; Psychotic Disorders; Quadriplegia; Quetiapine Fumarate; Tomography, X-Ray Computed

This research assesses the development of the night-activity rhythm and quality of sleep during course of treatment among patients with unipolar or bipolar depression and receiving antidepressant treatment plus quetiapine. Twenty-seven patients with major depressive episode were included into a 4-week follow-up study and compared with 27 healthy controls. Motor activity was continuously measured with an electronic wrist device (actigraphy), sleep was assessed with the Pittsburgh Sleep Quality Index, and patients were clinically assessed with the Hamilton depression score. All patients received a standard antidepressant treatment plus quetiapine. Whereas we found a rapid and maintaining improvement of subjective sleep parameters during the 4-week study, we observed a rapid improvement of some objective sleep parameters (actigraph) within the first week, but no further significant change of objective sleep parameters during the rest of the study. Another main finding of this study is that changes of subjectively and objectively assessed sleep parameters do not necessarily reflect clinical improvement of depression during the same timeline. Despite partial clinical remission, objective sleep parameters still showed significantly different patterns compared with controls. This study is the first to examine the effect of quetiapine on locomotor activity alongside with sleep in depression. As the studied patients with depression showed improvement in subjective and objective sleep parameters, quetiapine may be a promising drug for patients with depression and insomnia. Further studies need to investigate in detail the timeline of clinical remission and alterations of objective and subjective sleep parameters.

Topics: Adult; Aged; Antidepressive Agents; Antipsychotic Agents; Bipolar Disorder; Case-Control Studies; Circadian Rhythm; Depressive Disorder; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Motor Activity; Polysomnography; Psychiatric Status Rating Scales; Quetiapine Fumarate; Research Design; Sleep; Sleep Initiation and Maintenance Disorders; Time Factors

Quetiapine is a novel antipsychotic, which is efficacious in the treatment of positive and negative symptoms in schizophrenia. Research has shown that atypical antipsychotic also reduce the craving and consumption for stimulants and alcohol. Due to Quetiapine's particulars and the promising receptor profile concerning addiction medicine, we set out to examine the tolerability and efficacy concerning relapse prevention of withdrawn alcoholics suffering from craving and affective symptoms.. Our case observations attempted to evaluate nine alcoholics after withdrawal suffering from persisting craving, sleep disorder, excitement, depressive symptoms or anxiety symptoms. The patients were treated with quetiapine as relapse prevention and we followed them up in our outpatient clinic.. Eight out of nine patients were abstinent under quetiapine over a period of 2-7 months. One of these patients relapsed after he stopped taking the preparation at his own initiative after 10 weeks. The ninth patient stopped taking the preparation immediately because of swollen nasal mucosae. All target symptoms disappeared in the patients after an average of (mean+/-S.D.) 24.5+/-18.1 days. The overall tolerability was considered to be very good; however, initial sleepiness appeared in four patients.. Although uncontrolled case observations can only be interpreted with caution quetiapine seems to deserve further investigation and may hold the potential for preventing alcohol relapse in alcoholics suffering from additional above-mentioned symptoms.

Topics: Adult; Affect; Affective Symptoms; Alcoholism; Antipsychotic Agents; Anxiety Disorders; Depressive Disorder; Dibenzothiazepines; Female; Humans; Male; Middle Aged; Psychomotor Agitation; Quetiapine Fumarate; Secondary Prevention; Sleep Stages; Sleep Wake Disorders; Temperance; Time Factors; Treatment Outcome

Topics: Adolescent; Antipsychotic Agents; Citalopram; Depressive Disorder; Dibenzothiazepines; Drug Synergism; Drug Therapy, Combination; Female; Humans; Obesity; Psychotic Disorders; Quetiapine Fumarate; Selective Serotonin Reuptake Inhibitors; Weight Gain

Many questions remain regarding the use of atypical neuroleptics as antidepressant augmentation agents. To date, there have been no reports in the literature regarding the effectiveness of these drugs when trials of one or more of them have failed previously as antidepressant augmentation.. This retrospective chart review was conducted to determine the effectiveness of olanzapine, risperidone, quetiapine, and ziprasidone when given in a fee-for-service setting as anti-depressant augmentation agents to patients with treatment-resistant, nonpsychotic major depressive disorder (DSM-IV). Prospective (Global Assessment of Functioning [GAF]) along with retrospective (Clinical Global Impressions-Improvement [CGI-I] and -Severity of Illness scales) ratings were completed for each patient. Analyses were conducted in an attempt to identify factors that appeared to correlate with response, including order of administration and Thase-Rush staging of treatment resistance.. In this study of 76 medication trials in 49 patients, the overall response rate based on the CGI-I ratings was 65% (32/49). Individual rates of response were 57% (21/37) for olanzapine, 50% (7/14) for risperidone, 33% (6/18) for quetiapine, and 10% (1/10) for ziprasidone. None of the differences between neuroleptics in rates of response were significant. The difference between baseline and final GAF scores was statistically significant only in the olanzapine (p <.001) and risperidone (p =.047) groups. Rates of discontinuation did not vary significantly between agents, though trends were present. Crossover trials from one atypical neuroleptic to another in the event of nonresponse appeared to be effective.. Although limited by its design, this study suggests atypical neuroleptic augmentation of antidepressants may be a viable option in treatment-resistant major depressive disorder.

Topics: Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Depressive Disorder; Dibenzothiazepines; Drug Therapy, Combination; Female; Humans; Male; Medical Records; Olanzapine; Piperazines; Psychiatric Status Rating Scales; Quetiapine Fumarate; Research Design; Retrospective Studies; Risperidone; Thiazoles; Treatment Outcome

Two children with Tourette's syndrome and comorbid disorders were treated with quetiapine, an atypical antipsychotic successfully used in patients with psychoses and schizophrenia with low incidence of extrapyramidal side effects. Clinical observations and standardized rating scales suggested that this drug produced beneficial effects on tics and other symptoms. Adverse effects (at low doses) were minimal. Because it was suggested that tic efficacy of the newer antipsychotics was related to higher D2 occupancy (with the exception of quetiapine and clozapine, which have relatively low D2 activity), it is hypothesized that tic patients are D2 sensitive and need lower doses of medications. These children were treated naturalistically and were reported retrospectively because of their encouraging outcomes. However, these findings should be interpreted with caution, because no contrast groups, drug withdrawal, or placebo were utilized. Controlled studies are needed to determine the efficacy of quetiapine in the treatment of Tourette's syndrome.

Topics: Adolescent; Antipsychotic Agents; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Basal Ganglia Diseases; Depressive Disorder; Dibenzothiazepines; Dyskinesia, Drug-Induced; Humans; Male; Psychiatric Status Rating Scales; Quetiapine Fumarate; Tourette Syndrome

Topics: Adolescent; Antipsychotic Agents; Bipolar Disorder; Depressive Disorder; Dibenzothiazepines; Humans; Male; Psychotic Disorders; Quetiapine Fumarate

Topics: Adolescent; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Depressive Disorder; Dibenzothiazepines; Fluoxetine; Hallucinations; Humans; Male; Psychotic Disorders; Quetiapine Fumarate

In controlled studies of patients with schizophrenia, the atypical antipsychotic quetiapine, 300 mg/day, has been shown to be as effective in the treatment of positive and negative symptoms as haloperidol. However, little is known about the efficacy of quetiapine in patients with psychotic mood disorders. The purpose of this study was to assess the efficacy of quetiapine in the treatment of psychotic mood disorders in comparison with nonaffective psychotic disorders and identify clinical factors associated with quetiapine response.. In a naturalistic setting, by reviewing medical records, we assessed response to quetiapine and factors associated with response to quetiapine in 145 consecutive patients newly treated with the drug at a nonprofit academic psychiatric hospital. These patients had received a discharge diagnosis of bipolar disorder (manic, mixed, or depressive type), major depression with psychotic features, schizophrenia, schizoaffective disorder (bipolar or depressive type), delusional disorder, or psychosis not otherwise specified (NOS) according to DSM-IV criteria.. Patients with a diagnosis of bipolar disorder, manic, mixed, or depressed and schizoaffective disorder, bipolar type displayed higher response rates (> 74%) compared with patients with schizophrenia. However, this finding did not achieve statistical significance. A diagnosis of major depression with psychotic features (p = .02) and longer duration of illness (p = .03) were associated with less chance of responding.. Quetiapine may be a useful alternative or adjunctive treatment for patients with bipolar and schizoaffective disorders.

Topics: Adult; Affective Disorders, Psychotic; Antipsychotic Agents; Bipolar Disorder; Chronic Disease; Depressive Disorder; Dibenzothiazepines; Female; Hospital Records; Humans; Male; Prognosis; Psychotic Disorders; Quetiapine Fumarate; Retrospective Studies; Schizophrenia; Schizophrenia, Paranoid; Schizophrenic Psychology; Severity of Illness Index; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Anxiety Disorders; Benzodiazepines; Comorbidity; Depressive Disorder; Dibenzothiazepines; Female; Humans; Male; Middle Aged; Olanzapine; Pirenzepine; Quetiapine Fumarate; Risperidone

To describe a case of hyperventilation associated with the administration of quetiapine.. A 69-year-old African-American woman admitted to a psychiatric hospital for treatment of major depression with psychotic features was treated and successfully discharged with quetiapine, along with metronidazole and miconazole to treat bacterial/monilial vaginitis. Three days after discharge, the patient presented to a community hospital with shortness of breath and hyperventilation. The patient was admitted and treated for tachypnea and acute respiratory alkalosis. During this hospitalization, the patient was noted to have increased respiratory rate following the administration of quetiapine.. Hyperventilation was reported during the clinical trials of quetiapine; however, this is the first published report to date. Serotonin is involved both centrally and peripherally in the regulation of respiration. A contributing factor in this case may have been the concomitant administration of metronidazole, which inhibits the cytochrome P450 enzyme (CYP3A4) also responsible for the metabolism of quetiapine.. The development of hyperventilation and respiratory alkalosis was associated with the administration of quetiapine.

Topics: Aged; Alkalosis, Respiratory; Antipsychotic Agents; Antitrichomonal Agents; Depressive Disorder; Dibenzothiazepines; Drug Interactions; Female; Humans; Hyperventilation; Metronidazole; Quetiapine Fumarate