Effectiveness of quetiapine in the management of psychotic depression in an adolescent boy with bipolar disorder, mixed, with psychosis.
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ABSTRACT: This randomized, double-blind, placebo-controlled study examined the efficacy and tolerability of quetiapine in combination with divalproex (DVP) for acute mania in adolescents with bipolar disorder. It was hypothesized that DVP in combination with quetiapine would be more effective than DVP alone for treating mania associated with adolescent bipolar disorder. Furthermore, it was hypothesized that quetiapine would be well tolerated. Thirty manic or mixed bipolar I adolescents (12-18 years) received an initial DVP dose of 20 mg/kg and were randomly assigned to 6 weeks of combination therapy with quetiapine, which was titrated to 450 mg/day (n = 15) or placebo (n = 15). Primary efficacy measures were change from baseline to endpoint in Young Mania Rating Scale (YMRS) score and YMRS response rate. Safety and tolerability were assessed weekly. The DVP + quetiapine group demonstrated a statistically significantly greater reduction in YMRS scores from baseline to endpoint than the DVP + placebo group (F(1,27) = 5.04, p =.03). Moreover, YMRS response rate was significantly greater in the DVP + quetiapine group than in the DVP + placebo group (87% versus 53%; Fisher exact test, p =.05). No significant group differences from baseline to endpoint in safety measures were noted. Sedation, rated as mild or moderate, was significantly more common in the DVP + quetiapine group than in the DVP + placebo group. The findings of this study indicate that quetiapine in combination with DVP is more effective for the treatment of adolescent bipolar mania than DVP alone. In addition, the results suggest that quetiapine is well tolerated when used in combination with DVP for the treatment of mania.Journal of the American Academy of Child & Adolescent Psychiatry 11/2002; 41(10):1216-23. DOI:10.1097/00004583-200210000-00011 · 6.35 Impact Factor
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ABSTRACT: The available literature on the use of atypical antipsychotics for the treatment of bipolar disorder was reviewed. All uncontrolled and controlled reports were identified through a comprehensive Medline search. Based on the available evidence, olanzapine was found to be the most appropriate atypical antipsychotic agent utilized for the treatment of manic bipolar patients, although there is also preliminary data suggesting the efficacy of risperidone and clozapine. The preliminary data evaluating the efficacy of quetiapine and ziprasidone in bipolar disorder are still very limited. Double-blind controlled studies with atypical antipsychotics in the long-term treatment of bipolar disorder are still largely not available, but will be critical to determine the effectiveness of these agents in the maintenance treatment of bipolar disorder. There are recent uncontrolled suggestions that olanzapine may have beneficial effects in depressed bipolar patients, which deserve further investigation in controlled studies. In conclusion, atypical antipsychotics, due to lower potential for neurotoxicity and preliminary evidence suggesting better efficacy than typical antipsychotics, are increasingly having a more prominent role in the pharmacological management of bipolar patients. Nonetheless, until there is systematic data from long-term controlled follow-up studies on the comparative efficacy of these agents with mood stabilizers, atypical antipsychotics should be cautiously utilized, and preferably in combination with a mood stabilizer for the maintenance phase of treatment.Psychopharmacology 05/2003; 166(4):315-32. DOI:10.1007/s00213-002-1322-9 · 3.99 Impact Factor
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ABSTRACT: The case of a 15-year-old girl is reported, who suffered from depression and comorbid bulimia nervosa. Her suicidal behaviour worsened with parallel improvement of bulimic symptoms during fluoxetine treatment. These symptoms reversed after the medication was changed to mirtazapine and quetiapine. The small dose of quetiapine was used as an adjunct to the antidepressant treatment, and it resulted in dramatic improvement of mood, cessation of suicidal ideation and return of normal psychosocial functioning. It is suggested that the anti-bulimic effect of fluoxetine is independent of the antidepressant effect. Worsening of suicidal symptoms during fluoxetine treatment warrants a change of antidepressant. Qutiapine may be useful as an adjunct to antidepressants in the management of treatment resistant depression.International Journal of Psychiatry in Clinical Practice 09/2003; 7(3):213-216. DOI:10.1080/13651500310001554 · 1.31 Impact Factor