Quetiapine augmentation of paroxetine CR for the treatment of refractory generalized anxiety disorder: preliminary findings.
ABSTRACT More data are needed to guide "next step" strategies for patients with generalized anxiety disorder (GAD) remaining symptomatic despite initial pharmacotherapy.
This study prospectively examined the relative efficacy of quetiapine versus placebo augmentation for individuals with GAD remaining symptomatic with initial paroxetine CR pharmacotherapy.
Adult outpatients with GAD were recruited from 2004 to 2007 at two academic centers. Phase 1 consisted of 10 weeks of open-label paroxetine CR flexibly dosed to a maximum of 62.5 mg/day. Those remaining symptomatic (Hamilton Anxiety Scale [HAM-A] >or= 7) at week 10 were randomized to quetiapine or placebo augmentation flexibly dosed from 25 to 400 mg/day.
For participants receiving paroxetine CR (n = 50), there was a significant reduction in HAM-A scores (baseline mean +/- SD = 22.4 +/- 4.2 to endpoint mean +/- SD = 11.2 +/- 6.9; paired t = 12.1, df = 49, t < 0.0001) with 40% (n = 20) achieving remission. Counter to our hypothesis, we did not find significant benefit for quetiapine augmentation of continued paroxetine CR (HAM-A reduction mean +/- SD = 2.6 +/- 5.8 points quetiapine, 0.3 +/- 5.5 points placebo; t = 0.98, df = 20, p = n.s.) in the randomized sample (n = 22) with relatively minimal additional improvement overall in phase 2.
Although conclusions are considered preliminary based on the relatively small sample size, our data do not support the addition of quetiapine to continued paroxetine CR for individuals with GAD who remain symptomatic after 10 weeks of prospective antidepressant pharmacotherapy and suggest that further research examining strategies for GAD refractory to antidepressants is needed.
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ABSTRACT: The use of antipsychotic drugs, particularly quetiapine, has increased at an unprecedented rate in the last decade, primarily in relation to nonpsychotic indications. This increased use is concerning because of the high rates of metabolic and extrapyramidal side effects and inadequate monitoring of these complications. The purpose of this study was to measure the use of quetiapine and other second-generation antipsychotics by primary care physicians and psychiatrists and the most common diagnoses associated with quetiapine recommendations. We analyzed data on antipsychotic use from the IMS Brogan Canadian CompuScript Database and the Canadian Disease and Treatment Index, with a focus on quetiapine. We looked at the number of dispensed prescriptions for second-generation antipsychotics written by primary care physicians and psychiatrists and the diagnoses associated with recommendations for quetiapine from 2005 to 2012. Between 2005 and 2012, there was a 300% increase in dispensed prescriptions for quetiapine ordered by family physicians: from 1.04 million in 2005 to 4.17 million in 2012. In comparison, dispensed prescriptions from family physicians for risperidone increased 37.4%: from 1.39 million in 2005 to 1.91 million in 2012; those for olanzapine increased 37.1%, from 0.97 million in 2005 to 1.33 million in 2012. Dispensed prescriptions for quetiapine ordered by psychiatrists increased 141.6%: from 0.87 million in 2005 to 2.11 million in 2012. The top 4 diagnoses associated with quetiapine in 2012 were mood disorders, psychotic disorders, anxiety disorders and sleep disturbances. A 10-fold increase in quetiapine recommendations for sleep disturbances was seen over the study period, with almost all coming from family physicians. These findings indicate a preferential increase in the use of quetiapine over other antipsychotic drugs and show that most of the increased use is a result of off-label prescribing by family physicians.10/2014; 2(4):E225-E232. DOI:10.9778/cmajo.20140009
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ABSTRACT: Los antipsicóticos atípicos se utilizan de manera creciente en el tratamiento de los trastornos de ansiedad, ya sea en monoterapia o como tratamiento combinado. Esta es la primera revisión en la que se presenta el uso de los antipsicóticos atípicos en monoterapia o como potenciación en pacientes con trastornos de ansiedad primarios o con (trastornos) de ansiedad correspondientes a una comorbilidad de la esquizofrenia, el trastorno bipolar (TBP) o el trastorno depresivo mayor (TDM). Incluimos en la revisión un total de 49 ensayos de diseño abierto, 32 ensayos aleatorizados y controlados con placebo (EACpl) y 5 ensayos aleatorizados y controlados sin un grupo placebo, con casi 6.000 pacientes (diseño abierto: 1.710, aleatorizados: 4.145). Un número creciente de EACpl muestran resultados prometedores en un 27-71% de los pacientes con trastornos de ansiedad primarios o comórbidos tratados con antipsicóticos atípicos en monoterapia o con un tratamiento de potenciación. Sin embargo, las deficiencias metodológicas de los estudios incluidos pueden limitar las conclusiones de esta revisión y está justificada la realización de ensayos controlados con placebo más amplios para comparar el tratamiento estándar en monoterapia o de potenciación con antipsicóticos atípicos frente al de placebo. Además, las tasas de abandono del tratamiento más elevadas y los efectos secundarios del empleo de antipsicóticos atípicos pueden limitar el uso de estos fármacos en pacientes con trastornos de ansiedad.12/2012; 19:21-41. DOI:10.1016/j.psiq.2012.10.002
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ABSTRACT: Anxiety and related disorders include generalised anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder and phobic disorders (intense fear of an object or situation). These disorders share the psychological and physical symptoms of anxiety, but each disorder has its own set of characteristic symptoms. Anxiety disorders can be difficult to recognise, particularly in older people (those aged over 65 years). Older people tend to be more reluctant to discuss mental health issues and there is the perception that older people are generally more worried than younger adults. It is estimated that between 3 and 14 out of every 100 older people have an anxiety disorder. Despite treatment, some people will continue to have symptoms of anxiety. People are generally considered to be 'resistant' or 'refractory' to treatment if they have an inadequate response or do not respond to their first treatment. Older adults with an anxiety disorder find it difficult to manage their day-to-day lives and are at an increased risk of comorbid depression, falls, physical and functional disability, and loneliness.Health technology assessment (Winchester, England) 08/2014; 18(50):1-60. DOI:10.3310/hta18500 · 5.12 Impact Factor