Quetiapine augmentation in treatment-resistant depression: A naturalistic study

Department of Psychiatry, Clinical Hospital Centre Zagreb, Kispatićeva 12, Zagreb, Croatia.
Psychopharmacology (Impact Factor: 3.88). 10/2006; 187(4):511-4. DOI: 10.1007/s00213-006-0452-x
Source: PubMed

ABSTRACT Treatment-resistant depression (TRD) is a common clinical problem, often complicated with suicidal ideations and greater lifetime functional impairment, and represents a considerable challenge to management and treatment.
The aim of a prospective, open-label, noncomparative, flexible-dosed 20-week study was to evaluate the effects of quetiapine, as an add-on therapy, in patients with TRD who were refractory to previous treatments.
Eighteen patients with major depressive disorder (DSM-IV criteria) were treated for 20 weeks with quetiapine (mean dose 315+/-109 mg/day). Patients were evaluated at baseline, weekly from 1 to 9 weeks, and then after 12, 16, and 20 weeks of treatment, using Hamilton rating scale for depression-17 items (HAMD) scale.
Fourteen patients with TRD completed the 20-week open trial with quetiapine. The augmentation with quetiapine significantly reduced total scores and scores listed in the anxiety subscale on the HAMD, and these effects were observed after the fourth week of treatment, while the depressed mood scores were significantly reduced after the fifth week of treatment. Quetiapine add-on treatment significantly decreased the scores listed in the insomnia subscale on the HAMD subscale after the second week of treatment.
Our preliminary data indicate that quetiapine add-on therapy appears to have beneficial effects in the treatment of patients with TRD.

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    • "In addition, the onset of antidepressant action during treatment with QXR appears to be earlier than that of conventional antidepressant drugs such as duloxetine (Cutler et al., 2009). The efficacy of quetiapine or QXR as an augmentation strategy in the treatment of major depressive episodes has also been shown in several controlled (McIntyre et al., 2007; Bauer et al., 2010; El-Khalili et al., 2010) or open-label (Devarajan et al., 2006; Sagud et al., 2006; Anderson et al., 2009) trials. "
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    ABSTRACT: Background In this study, the impact of quetiapine fumarate extended release (QXR) and escitalopram (ESC) on HPA axis activity was investigated in depressed patients in relationship to antidepressant efficacy. Methods In a randomized, open-label 5-week trial 60 inpatients suffering from major depression (DSM-IV criteria) were treated for 5 weeks with either QXR (300 mg/day) or ESC (10 mg/day). The dexamethasone/CRH (DEX/CRH) test was performed before treatment, after 1, and after 5 weeks of treatment. Cortisol (COR) AUC values were used to assess HPA axis function. The Hamilton Depression Rating Scale was used weekly to estimate antidepressant efficacy. Results QXR and ESC showed comparable antidepressant effects but strongly differed in their impact on HPA axis activity. In the QXR group, a marked inhibition of COR AUC levels was observed which was most pronounced after one week of treatment but showed a partial re-increase after 5 weeks of treatment. In contrast, ESC transiently stimulated COR AUC values (week 1) whereas COR AUC levels at week 0 and week 5 were comparable. COR improvement at week 1 (defined as COR peak value reduction between DEX/CRH test 1 and 2) was significantly associated with better clinical outcome. Conclusion Apparently, different effects on HPA axis activity reflect distinct pharmacoendocrinological properties of psychotropic drugs.
    Psychoneuroendocrinology 12/2014; 39(1):141–151. DOI:10.1016/j.psyneuen.2013.10.008 · 4.94 Impact Factor
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    • "a Preliminary studies have shown that quetiapine is efficacious in antidepressant augmentation for individuals with non-psychotic depressive disorders with residual anxiety and depressive symptoms (McIntyre, et al., 2006). Meta analyses (Papakostas, et al., 2007) and naturalistic studies (Sagud, et al., 2006; Dorée, et al., 2004) have also demonstrated the potential beneficial effects of quetiapine augmentation in treatment resistant depression. Although not licensed for use in major depressive disorder, such off-label prescription accounts for significant use of quetiapine in clinical practise (Rowe, 2007; Taylor, et al., 2008). "
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    ABSTRACT: 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.
    Journal of Psychopharmacology 04/2009; 24(4):565-72. DOI:10.1177/0269881108100774 · 3.59 Impact Factor
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    • "After the fi fth week of treatment, scores on the HAM-D depressed mood subscale were also signifi cantly reduced. Quetiapine addon therapy was also associated with a signifi cant decrease in the HAM-D insomnia subscale after the second week of treatment (Sagud et al 2006). "
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    ABSTRACT: Atypical antipsychotics are increasingly used in the treatment of a broad spectrum of psychiatric disorders. There is evidence that in addition to treating the positive and negative symptoms of schizophrenia, as well as mania in bipolar disorder, these agents may have a potential role to play in the treatment of depressive disorders. In the following article we review the literature regarding the role of atypical antipsychotics, and specifically, quetiapine, in the treatment of major depressive disorder. In March 2007 the authors performed a Medline search (English-language) using the keywords quetiapine and depression, revealing a total of 47 articles published. We also looked for cross-references in the published articles, obtained data-on-file from AstraZeneca Pharmaceutical L.P., and included abstracts presented at conferences and recent meetings. From our review we found that there is increasing literature supporting the efficacy of add-on quetiapine in the treatment of major depressive disorder. There is a need, however, for further well-designed, adequately powered, randomized, controlled trials to confirm this finding, specifically in unipolar depression.
    Neuropsychiatric Disease and Treatment 01/2008; 3(6):855-67. · 1.74 Impact Factor
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