ArticlePDF AvailableLiterature Review

Quetiapine in substance use disorders, abuse and dependence possibility: A review



Quetiapine is an atypical antipsychotic approved by the FDA (Food and Drug Administration) for use in the treatment of schizophrenia, acute mania, and bipolar depression. Pharmacologically, it has antagonistic effects on serotonin 5-HT1A and 5-HT2A, dopamine D1 and D2, histamine H1, and adrenergic alpha1 and alpha2 receptors. In addition to reports of its use in schizophrenia and bipolar disorder, many studies have examined the use of quetiapine in the treatment of anxiety disorders and substance use disorders. In the treatment of patients with psychotic or bipolar disorder with a comorbid substance abuse disorder even though quetiapine was prescribed primarily for the treatment of the underlying psychotic symptoms, patients taking this medication reported a significant reduction in substance use. Yet, there are also case reports of quetiapine abuse and dependence; in particular among prisoners and patients diagnosed with substance abuse. Though quetiapine should be used peroral, it is also used intranasally and intravenously in these patient groups. Moreover, in some cases quetiapine is combined with other substances, such as cocaine or marijuana, to increase sedation. This abuse of quetiapine is thought to occur due to the anxiolytic and sedative effects of the drug. There are no controlled studies on quetiapine dependence in the literature and it remains unknown whether or not quetiapine causes dependence. This review aimed to present all published case reports on quetiapine abuse and to discuss the possible mechanisms that underlie its abuse and dependence.
Türk Psikiyatri Dergisi 2010;
Turksh Journal of Psychatry
Quetiapine is an atypical antipsychotic approved by the FDA (Food and Drug Administration) for use in the
treatment of schizophrenia, acute mania, and bipolar depression. Pharmacologically, it has antagonistic effects
on serotonin 5-HT1A and 5-HT2A, dopamine D1 and D2, histamine H1, and adrenergic α1 and α2 receptors. In addition
to reports of its use in schizophrenia and bipolar disorder, many studies have examined the use of quetiapine
in the treatment of anxiety disorders and substance use disorders. In the treatment of patients with psychotic
or bipolar disorder with a comorbid substance abuse disorder even though quetiapine was prescribed primarily
for the treatment of the underlying psychotic symptoms, patients taking this medication reported a significant
reduction in substance use. Yet, there are also case reports of quetiapine abuse and dependence; in particular
among prisoners and patients diagnosed with substance abuse. Though quetiapine should be used peroral, it is
also used intranasally and intravenously in these patient groups. Moreover, in some cases quetiapine is combined
with other substances, such as cocaine or marijuana, to increase sedation. This abuse of quetiapine is thought
to occur due to the anxiolytic and sedative effects of the drug. There are no controlled studies on quetiapine
dependence in the literature and it remains unknown whether or not quetiapine causes dependence. This review
aimed to present all published case reports on quetiapine abuse and to discuss the possible mechanisms that
underlie its abuse and dependence.
Key Words: Quetiapine, abuse, dependence, substance use disorders
Que apine in Substance Use Disorders, Abuse and
Dependence Possibility: A Review
Received: 05.04.2009 - Accepted: 31.08.2009
Assist. Prof./MD., Gaziosmanpasa University Faculty of Medicine, Psychiatry Department, Tokat
Serap Erdoğan, MD., e-mail:
Quetiapine is considered as an atypical antipsychotic
and has been approved by the FDA (Food and Drug
Administration) for use in the treatment of schizophre-
nia, acute mania, and bipolar depression. Quetiapine, a
dibenzodiazepine derivative, is pharmacologically similar
to clozapine and has an antagonistic effect on serotonin
5-HT1A and 5-HT2A, dopamine D1 and D2, histamine
H1, and adrenergic α1 and α2 receptors (Goldstein 1999;
Reeves and Brister 2007; Riedel et al. 2007). In addition
to its similarity to clozapine, quetiapine has the advantage
of not causing agranulocytosis. Its affinity for 5-HT2A
receptors is much stronger than its affinity for D2 recep-
tors; consequently, it is thought to cause fewer extrapy-
ramidal side effects (Green 1999). Furthermore, hyperpro-
lactinemia that is another side effect of antipsychotics , is less
frequently encountered with quetiapine use.. Unlike other
atypical antipsychotics, the fact that quetiapine tempo-
rarily attaches to postsynaptic D2 receptors and detaches
from them in a short time contributes to its reliable side
effect profile (Kapur et al. 2000). At the lower end of
quetiapine’s suggested dosage level (50-750 mg/day) is
thought that it does not have any significant affinity
for cholinergic muscarinic receptors or benzodiazepine
receptors. Nevertheless, doses above 500 mg/day more
frequently cause anticholinergic effects, such as dysuria,
constipation, and dry mouth (Morin 2007).
Apart from quetiapine’s use in schizophrenia and
bipolar affective disorder, an extensive body of research
on its off-label use exists. In Rowe’s (2007) study, au-
thors added low doses of quetiapine to the treatment of
resistant cases when, in particular, selective serotonin
re-uptake inhibitors and cognitive behavioral therapy
remained inadequate. Thus, it was reported that quetiap-
ine is suggested for patients with obsessive-compulsive
disorder, prost-traumatic stress disorder, substance use
disorder, personality disorder, and anxiety and depres-
sive disorder. Similarly, a study conducted by Philip et al.
(2008) analyzed prescriptions over a 2-year period and
reported that quetiapine was mostly used off-label in the
treatment of depression, followed by the treatment of bi-
polar and psychotic disorders comorbid with substance
use disorder. In addition, a growing number of case re-
ports on the misuse of quetiapine have been published
(Pierre et al. 2004; Hussain 2005; Morin 2007). It is
noteworthy that these cases generally consist of prison-
ers and patients with a history of multiple substance de-
pendence. When designing and monitoring treatment,
doctors particularly interested in these groups of patients
should be careful about the use of quetiapine alone or in
combination with other substances that might or might
not be addictive.
Quetiapine use among prisoners that were brought
from a closed prison in the town to the psychiatric clinic
of Osmaniye State Hospital for medical examination,
have some similarities to cases of quetiapine abuse re-
ported in the literature. In all, 14 prisoners out of 330
were prescribed quetiapine, and these prisoners were
diagnosed with multiple substance use and antisocial
personality disorder. It was reported that the quetiapine
treatment began before or after imprisonment at various
clinics and that the prisoners insisted on using quetiap-
ine. In fact, some of the prisoners refused to leave the in-
terview room unless they were prescribed quetiapine. In
particular, patients with a history of substance depend-
ence consistently demanded quetiapine from the prison
doctors, and they did not want to use drugs with seda-
tive effects, such as mirtazapine and trazodone, which
were prescribed by psychiatrists. The prison guards and
doctors observed that the prisoners attempted to give
quetiapine to each other. Additionally, during psychi-
atric interviews some prisoners reported that they col-
lected quetiapine given to them as a daily dose, and then
consumed 600-800 mg of quetiapine in a single dose in
order to feel calm.
This review, written based on the reports mentioned
above, aimed to examine published case reports on the
possible abuse of quetiapine and quetiapine dependence,
as well as the relationship between substance use disorder
and quetiapine. To meet this objective the Turkish and
foreign psychiatric publications were searched. Turkish
and foreign articles published between 1990 and 2009
were searched through the Turkish national (ULAKBİM
Türk Tıp Dizini, Türk Psikiyatri Dizini) and interna-
tional databases (PubMed, EMBASE, and ISI Web of
Science) using different combinations of the key words
mentioned in the abstract. Case reports, reviews, and
meta-analyses were searched, and those that were appro-
priate for this review were examined.
Quetiapine in the Treatment of Substance Use
The use of quetiapine in the treatment of substance
use disorders has been studied in populations of patients
diagnosed with comorbid schizophrenia and bipolar dis-
orders (Brown et al. 2002; Sattar et al. 2004; Martinotti
et al. 2008). Substance use disorders were diagnosed
2-3 times more frequently in patients with schizophre-
nia than in the control group (Potvin et al. 2008). This
high comorbidity rate is thought to originate from the
common biological roots of these two disorders. It was
posited that dopamine sensitivity in the schizophrenic
patients made them more susceptible to the rewarding
effect of the substance (Hanley and Kenna 2008). In ad-
dition, the endogenous cannabinoid system is thought
to play a role in both disorders (Potvin et al. 2008). Simi-
larly, about 50% of patients with bipolar disorder had a
history of substance abuse disorder (Brown et al. 2002).
After antipsychotic treatment was administered to
control psychotic symptoms it was observed that the
quantity of substance used by patients decreased (Volkow
et al. 2002). On the other hand, some studies reported
that antipsychotic use increases the amount of substance
used by patients diagnosed only with a substance use dis-
order (McEvoy et al. 1995). These differing results are
thought to be the result of variation in the mechanisms
of effect of different antipsychotic drugs. While low-po-
tency antipsychotics decrease the quantity of substance
taken, high-potency antipsychotics increase the quantity
taken (Sattar et al. 2004). Green et al. (1999) argue that
this phenomenon is related to the dopaminergic an-
tagonism created by antipsychotic drugs in the reward
pathway in mesocorticolimbic neurons. High-potency
antipsychotics have a stronger antagonistic effect, which
is thought to increase the quantity of substance taken to
reach the satisfaction felling (Martinotti et al. 2008).
Brown et al. (2002) investigated the efficacy of
quetiapine in patients with bipolar affective disorder with
comorbid cocaine dependence or substance abuse. They
reported that quetiapine alleviated mood symptoms and
decreased cocaine craving, but that there was no difference
in the amount of money spent for the substance used, the
frequency with which the substance was used, and the fre-
quency of positive urine test results for the substance used.
In another study, patients diagnosed with bipolar I, bipo-
lar II, schizoaffective disorder, and borderline personality
disorder, in addition to alcohol dependence, were given a
daily quetiapine dose of 300-800 mg for 16 weeks follow-
ing detoxification treatment. At the end of the study it was
observed that quetiapine decreased the psychiatric symp-
toms that accompanied alcohol consumption and craving
(Martinotti et al.,2008).
Other studies focused on the use of quetiapine in pa-
tients with alcohol and substance use disorders, but no
other comorbid psychiatric disorder. Sattar et al. (2004)
gave 50-300 mg/day of quetiapine to 9 patients with al-
cohol and substance dependence (cocaine and metham-
phetamine), in addition to antidepressant and anxiolytic
treatment for such complaints as anxiety and sleep with-
drawal. The researchers reported that 1 patient could not
tolerate the treatment because of increased anxiety, but
that anxiety and sleep withdrawal decreased in the other
8 patients. In a 6-week study conducted to evaluate the
efficacy of quetiapine in cocaine-addicted patients with-
out a psychotic disorder, 22 patients received 300-600
mg/day of quetiapine. Some of the patients could not
finish the study because of quetiapine’s sedative effect.
In particular, during the first week of the study a sig-
nificant decrease in cocaine craving was observed and
patients reported that the quantity of cocaine use de-
creased (Kennedy et al. 2008). Pinkofsky et al. (2005)
conducted a study with patients that were being treated
for opioid dependence, and every 4 hours gave them one
or two 25-mg quetiapine tablets,. According to the re-
sults, 79 of the 107 patients that completed the study
reported a decrease in opioid craving, 52 patients re-
ported decreased anxiety, 24 reported decreased somatic
pain, 22 reported a decrease in sleep withdrawal, and 14
reported increased appetite due to the use of quetiap-
ine. The researchers noted that 4 patients discontinued
quetiapine treatment because they did not benefit from
it and 7 patients stopped because they could not tolerate
the side effects.
A common theme in the studies summarized above is
that quetiapine can be used in the treatment of substance
use disorders. This suggestion brings to mind the abuse
and dependence possibility in the use of quetiapine; and
also there is a growing body of research that reveals these
kinds of case reports in the literature.
Data Related to the Possible Quetiapine Misuse
and Dependence
In the Diagnostic and Statistical Manual of Mental
Disorders (DSM IV), substance dependence criteria in-
clude behavioral (obtaining and using the substance for a
long time, failing to fulfill personal and social obligations
because of substance use, continuing substance use despite
damages and several attempts to quit) and physical (evi-
dence of tolerance and withdrawal when the substance is
nor taken) characteristics. On the other hand, substance
abuse is defined similarly to substance dependence in
terms of the behavioral problems, but does not include
the physical dependence criteria. In both conditions, the
symptoms should have occurred during the last 12-month
period and caused clinically severe deterioration (Ameri-
can Psychiatric Association 1994).
When evaluated in terms of DSM IV criteria it is
noteable that quetiapine abuse and dependence were first
reported among prisoner populations. In the Los Angeles
County Jail, which is referred to as the “world’s biggest
mental health institution”, it is reported that approxi-
mately 30% of prisoners pretend to have a severe psy-
chiatric disorder by reporting symptoms (hearing noises,
having paranoid thoughts) in order to get quetiapine
(Pierre et al. 2004). This is an important point, although
the prevalence of this kind of behavior is not known.
Research revealed that quetiapine is referred to in the
street language used by substance-dependent individuals
by such names as “seroquel”, “quell”, or “susie-Q”, and
that it is called “baby heroin” by prisoners (Reeves and
Brister, 2002; Waters and Joshi, 2007; Hanley and Ken-
na, 2008; Keltner and Vance, 2008). In Turkey, patients
with substance dependence and their doctors report that
one of the street names of quetiapine is “yellow lake.” In
addition, a foreign rap song mentions one of the com-
mercial names for quetiapine among the substances that
might cause dependence (Keltner and Vance 2008).
Quetiapine is not considered a substance that causes
dependence and its use is not under control. Hussain et
al. (2005) reported that quetiapine dependence among
prisoners might be more widespread than is thought, be-
cause obtaining other substances that can cause depend-
ence is more difficult. The fact that quetiapine is used
in the treatment of anxiety and sleep deprivation due to
substance withdrawal, which is frequently seen among
prisoners, is suggested to be another reason. Published
reports on quetiapine abuse will be briefly explained
below. Diagnoses of the cases and the characteristics of
quetiapine use are summarized in Table.
A case report published in 2005 tells of a 34-year-old
woman diagnosed with multiple substance dependence
(alcohol, heroin, and cocaine) and borderline personal-
ity disorder that had attempted suicide more than once
time dissolved two 300-mg quetiapine tablets in water,
which she then boiled and injected. The patient reported
that she slept for 12 hours and didn’t have euphoric, dys-
phoric, or any other effects, except for sedation (Hus-
sein et al. 2005). Another report on the intravenous use
of quetiapine presented a 33-year-old male patient with
multiple substance dependence (cocaine, alcohol, hero-
in, and benzodiazepine) that presented to an emergency
department for detoxification and rehabilitation. The
patient reported that he steals quetiapine prescribed for
his wife (400-800 mg/day), powders it and mixes it with
cocaine, dissolves it in water, filters it through a bandage,
and then injects it. The researchers noted that the pa-
tient used quetiapine in this way in order to experience
hallucinogenic effects (Waters and Joshi 2007).
It is known that quetiapine is used intranasally, as well
as intravenously. A case report by Morin (2007) revealed
that a white powder was found in the room of a 28-year-
old female patient diagnosed with bipolar schizoaffective
disorder, multiple substance abuse (alcohol, cocaine, ec-
stasy, lysergic aside diethylamide [LSD], weight loss pills
including ephedra, and some other drugs described as
“sedative” by the patient), tobacco dependence, and per-
sonality disorder. The patient intranasally took smashed
aspirin and quetiapine (given to her as a part of her treat-
ment) because of the sedative effect of quetiapine. Pierre
et al. (2004) also report that among the prisoners of the
Los Angeles County Jail, some people use quetiapine in-
Pinta and Taylor (2007) report that quetiapine causes
seeking behaviors observed in substance use disorders. It
is reported that a prisoner with opioid dependence and
hepatitis C infection that was taking 800 mg of quetiap-
ine and 0.9 mg of clonidine because of generalized anxi-
ety disorder reacted and could not adapt to the reduction
of quetiapine use, when his doctor wanted to gradually
discontinue quetiapine treatment because of its possible
effects on the patient’s liver. The patient attempted to
obtain quetiapine from other prisoners when quetiapine
treatment was terminated. In addition, when quetiapine
treatment is withdrawn, some prisoners that previously
used quetiapine react to the point of suicidal attempts
(Pinta and Taylor 2007).
In a study by Inciardi et al. (2007) on the abuse of
prescription drugs, they present a cased that reported
taking 4 “seroquel”, 3 “lilly (olanzapine)”, 2 “bar” (2 mg
of alprazolam), alcohol, marihuana, and cocaine at the
same time, having a “perfect” night. This report brings
to mind that the use of antipsychotic drugs in combina-
tion with substances causing dependence started to be a
common behavior.
Reeves and Brister (2007) presented 3 cases that they
consider examples of quetiapine abuse. The first case
was a 49-year-old male patient with a history of alcohol
dependence, and alprazolam and diazepam abuse. The
treatment of substance abuse started while the patient
was in prison, but when the patient was released on pro-
bation he reported having withdrawal symptoms. In re-
sponse, the patient began to obtain quetiapine from his
friends in order to sleep, knowing of its sedative effect
and that it cannot be identified in urine. After a short
while he began to take one 800-mg dose of quetiapine
each night, but his complaints of sleep withdrawal, ir-
ritability lasting all day, anxiety, and headache appeared
when he couldn’t obtain quetiapine. The patient then
presented to a clinician and insisted on being prescribed
at least 400 mg/day of quetiapine.
The second case was a 23-year-old male patient hos-
pitalized because of benzodiazepine dependence. His
detoxification treatment started with lorazepam, but
the patient consistently asked the doctors to give him
quetiapine because he heard that quetiapine is good for
withdrawal symptoms. Then patient then began to steal
quetiapine from his schizophrenic girlfriend and other
patients that used quetiapine in order to use and sell it.
It was noted that the patient used quetiapine when he
couldn’t obtain benzodiazepine and when he felt anxious
and uncomfortable, he sometimes took 1000-1200 mg
of quetiapine in a single dose, and he sometimes took up
to 2400 mg/day. The patient reported that in terms of
its calming effect, 200-300 mg quetiapine was equal to
1 mg of clonazepam.
The third case was a 39-year-old male patient with
bipolar affective disorder. This patient was treated with
quetiapine, but presented to a psychiatric clinic with
complaints of increased flow of thoughts, grandiose de-
lusions, and agitation, and insisted on being prescribed
800 mg d–1 quetiapine. The researchers reported that the
patient had been successfully treated with 400 mg/day
quetiapine, but that the patient confessed he consumed
the entire prescribed dose in a short time because he ex-
ceeded the dose suggested to him, and related his com-
plaints to not being able to find anymore quetiapine.
His treatment medication was changed to aripiprazole,
which does not have a sedative effect, but although his
symptoms were controlled, the patient consistently ex-
pressed that he did not like the new drug and wanted to
take quetiapine instead (Reeves and Brister 2007).
Murphy et al. (2008) presented a 29-year-old male
schizophrenic patient treated with 600 mg/day ( single
dose) quetiapine that presented to a psychiatric emergency
department with complaints of sleep disturbance because
he thought that the police were electronically monitoring
his testicles. The patient did get some sleep when he was
medicated. The next day at his assessment it was learned
that the patient did not have any symptoms related to a
psychotic disorder, but that he had been obtaining high
doses of quetiapine from different sources to use and sell.
The researchers warned doctors about people that present
in order to be prescribed quetiapine by describing psy-
chotic symptoms (Murphy et al. 2008).
In Turkey, Evren et al. (2009) report 3 cases they
thought might have abused quetiapine that were fol-
lowed-up at the Alcohol and Drug Addiction Treatment
and Research Center (AMATEM) of Bakirköy State Hos-
pital for Mental and Neurological Diseases. The first case
was a 32-year-old male patient diagnosed with heroin,
marijuana, benzodiazepine, and alcohol abuse, as well as
epilepsy, which was treated with diazepam, an analgesic,
an antiemetic, and an antidiareic to control withdrawal
symptoms, in addition to epilepsy treatment with sodium
valproate and lamotrigine. Mirtazapine was given to the
patient following his complaints of sleep withdrawal, but
the patient consitantly asked the doctors for quetiapine.
After being discharged from the hospital voluntarily he
took quetiapine prescribed by the night doctor as an ex-
tra drug from other inpatients, powdered it and used it
The second case presented with multiple substance de-
pendence, including heroin, that was taking risperidone
for irritability and delusions of persecution, and diazepam,
analgesic, antiemetic, and antidiareic treatment for with-
drawal symptoms. Because of the extrapyramidal side ef-
fects related to risperidone, the patient was prescribed 300
mg/day quetiapine, but his sleep problem continued and
quetiapine treatment was changed to 200 mg/day chlo-
rpromazine. Nonetheless, the patient insisted on being
prescribed quetiapine, and the outpatient clinic records
show that the patient had previously asked for quetiapine.
TABLE. Published quetiapine abuse case reports.
Author, publishing date Patient diagnosis Substances used together with quetiapine Method of use
Hussain et al., 2005 Polysubstance dependence
Borderline personality disorder
Not indicated Intravenous injection
Waters et al., 2007 Polysubstance dependence Cocaine Intravenous injection
Morin, 2007 Schizoaffective disorder (bipolar type)
Polysubstance abuse
Tobacco dependence
Personality disorder
Aspirin Intranasal
Pierre et al., 2007 Not indicated Not indicated Intranasal
Pinta et al., 2007 Opiate abuse
Generalized anxiety disorder
Clonidine Oral
Inciardi et al., 2007 Not indicated Olanzapine, alprazolam, alcohol, marijuana,
Reeves et al., 2007 Alcohol dependence
Alprazolam, diazepam abuse
Not indicated Oral
Benzodiazepine dependence Not indicated Oral
Bipolar affective disorder Not indicated Oral
Murphy et al., 2008 Not indicated Not indicated Oral
Evren et al., 2009 Heroin dependence, Marijuana,
benzodiazepine, alcohol abuse,
Sodium valproate, lamotrigine, diazepam,
analgesic, antiemetic, antidiareic drugs,
Polysubstance dependence Diazepam, analgesic, antiemetic, antidiareic
drugs, risperidone, chlorpromazine
Polysubstance dependence Diazepam, analgesic, antiemetic,
antidiareic drugs
The third case was a patient with multiple substance
dependence, including heroin. He repeatedly asked for
a higher dose of quetiapine even though he was treated
with 600 mg/day for his sleep withdrawal complaint. It
is reported that the patient had requested high doses of
quetiapine when he was an inpatient, although he did
not have any active psychotic symptoms (Evren et al.
Except for case reports, there are no studies on the
characteristics of quetiapine use among prison popula-
tions. In a Turkish study by Kaya et al. (2009), among
37 patients that were brought to the Ankara AMATEM
outpatient clinic from prison and asked to be prescribed
quetiapine, 21.6% developed tolerance to the drug and
40.5% obtained more quetiapine than the legal and sug-
gested dose for treatment. It was reported that when the
patients don’t take the drug, 100% of them have sleep
withdrawal symptoms, 70.3% exhibit nervousness, and
64.9% have withdrawal symptoms such as restlessness.
As these symptoms are in line with DSM-IV substance
dependence criteria, it appears that quetiapine has the
potential for substance abuse and dependence.
The mechanisms described below were highlighted
in studies that focused on the therapeutic use of quetiap-
ine in substance use disorders:
1. Quetiapine provides sedation via blockage of H1 re-
ceptors (Reeves and Brister 2007).
2. According to the self-medication hypothesis of
Khantzian, people start to take substances in order
to alleviate the symptoms of anxiety, and then de-
pendence develops. Quetiapine can reduce the effect
of dependence by reducing the symptoms of anxiety
(Khantzian 1985; Martinotti et al. 2008).
3. The affinity of quetiapine for dopamine receptors is
low, and quetiapine detaches a short time after it at-
taches (Morin 2007).
4. Substance-dependent patients have obsessive
thoughts related to the substance they use; the an-
tipsychotic effect of quetiapine helps to reduce these
thoughts (Martinotti et al. 2008).
5. Patients with substance use disorders are also diag-
nosed with personality disorders; quetiapine can in-
directly influence substance use by treating the psy-
chopathology (Evren et al. 2009).
Similarly, the potential for quetiapine abuse was reported
with the following explanations:
1. Quetiapine abuse is most frequently related to its
sedative and anxiolytic characteristics (Pinta and Tay-
lor 2007; Reeves and Brister 2007).
2. It is thought that the motivation for quetiapine abuse
is self-medication for the symptoms of anxiety and
sleep withdrawal, not the desire to get high (Pierre
et al. 2004; Reeves and Brister 2007; Kaya et al.
3. The fact that quetiapine rapidly detaches from D2 re-
ceptors may contribute to the its potential abuse, and
to the lack of euphoria or dysphoria as withdrawal
symptoms (Morin 2007).
4. The fact that quetiapine use is not under control and
other extensively used substances that might result
in dependence are difficult to obtain might lead to
quetiapine abuse (Inciardi et al. 2007; Pinta and Tay-
lor 2007).
Sedation is a frequently encountered side effect of
quetiapine. Calabrese et al. (2005) report that 29.6% of
patients that took 300 mg/day quetiapine and 32.2% of
patients that took 600 mg/day quetiapine experienced
sedation. The sedative effect of quetiapine significantly
increases when consumed at high doses, especially in
combination with alcohol and other sedative substances.
It is posited that its sedative effect is mostly related to H1
receptor antagonism. In addition, it is thought that anti-
dopaminergic and anti-serotonergic effects might have a
role in its sedative effect. In relation to this, it is known
that quetiapine is sometimes prescribed off-label for the
treatment of sleep withdrawal (Robert et al. 2005; Rowe
2007; Philip et al. 2008). The anxiolytic and sedative
effects of quetiapine help to alleviate such withdrawal
symptoms as anxiety, irritability, and sleep withdrawal
in patients with dependence to central nervous system
(CNS) stimulants or CNS-suppressive substances like
alcohol and opiates. From then on, the patients might
start to abuse quetiapine prescribed for treatment, which
is not controlled for its use.
Researchers argue that quetiapine intranasal or in-
travenous abuse is more common than thought (Pierre
et al. 2004; Hussain et al. 2005). Although there is no
evidence supporting this view, intranasal use of quetiap-
ine might work pharmacokinetically faster than oral use.
Patients might prefer the intranasal use of quetiapine
because its anxiolytic and sedative effects work faster
(Morin 2007).
On one hand, using prescribed drugs in combina-
tion with illegal substances prevents the toxic side effects
that might be caused by overdosing; on the other hand it
helps to intensify the desired effects. An example of this
is the intravenous use of cocaine together with heroin
(known as a “speedball”) (Waters and Joshi 2007). In a
case mentioned previously in this review, it is thought
that quetiapine was used instead of heroin together with
cocaine (the combination of cocaine and quetiapine is
known as a “Q-ball”). When the anxiolytic and sedative
effects of quetiapine reduces the dysphoria developed
due to the lack of cocaine in a short while, it might also
create a hallucinogenic effect as reported by the use itself.
The composition of the hallucinogenic effect mechanism
cannot be explained (Waters and Joshi 2007).
It is noteworthy that the case reports of quetiapine
abuse mostly involve patients with a substance use disor-
der. Only 1 case with bipolar affective disorder was ob-
served to increasingly use quetiapine (Reeves and Brister
2007). This might be because patients with a substance
use disorder use quetiapine for its sedative and anxiolytic
effects in order to reduce the irritability they experience
when they cannot take other substances (because they are
in prison, or cannot obtain other substances). It is pos-
sible to argue that the sedative and anxiolytic effects of
quetiapine (for which it is preferred in clinical settings)
might be why it’s used in the streets as well. These atti-
tudes toward quetiapine are considered to be similar the
abuse of anticholinergic drugs and low-potency antip-
sychotics such chlorpromazine and thioridazine, which
occurred in the past when atypical antipsychotics were
not commonly used (Pierre et al. 2004). In addition, it
has been reported that some patients had to be excluded
from studies because they couldn’t tolerate the sedation
associated with quetiapine (Kennedy et al. 2008). This
finding suggests that quetiapine abuse might not always
be related to the desire for sedation. In the treatment of
all substance use disorders, two crucial factors are pa-
tient motivation for treatment and patient expectations
of the treatment. Considering these factors, quetiapine
might become a replacement substance or abuse might
continue with quetiapine in patients with a low toler-
ance for anxiety, or expect to be away from the substance
for a short time, or can’t use the substance because of
the conditions (being in prison, in hospital, or under
surveillance because of the supervised liberty, or finan-
cial problems) they live in even though they dont expect
to be treated. The cases mentioned above show that the
behavioral characteristics of patients are primarily associ-
ated with substance use disorders. In the process of de-
veloping dependence, the role of the mesolimbic reward
system is critical.
The mesolimbic reward system originates in the
ventral tegmental area, and is related to the nucleus ac-
cumbens and the prefrontal cortex. The pathways in this
system contain dopaminergic neurons. The concentra-
tion of extracellular dopamine increases in the brain in
alcohol and substance dependence, even though it occurs
via different mechanisms (Blum et al., 2000). It is clear
that this mechanism is not activated in the process of
possible quetiapine abuse or dependence. Nevertheless,
the fact that quetiapine rapidly detaches from D2 recep-
tors might contribute not to have euphoria or dysphoria
due to the lack of the drug, but also to the potential of
quetiapine’s abuse (Morin 2007).
Quetiapine abuse is increasing and this might be
because clinicians prescribe fewer benzodiazepine, bar-
biturate, and stimulant drugs for substance dependence
treatment and in prisons because of their addictive char-
acteristics. The increase in quetiapine abuse might also
be related to increased use of quetiapine because of its
anxiolytic and sedative effects, and because it is thought
that it won’t result in dependence. In order to evaluate
this it might be useful to track quetiapine’s off-label pre-
scription use for the treatment of the symptoms of anxi-
ety, irritability, and sleep withdrawal over time.
Quetiapine is a drug approved by the FDA (Food
and Drug Administration) for use in the treatment of
schizophrenia, acute mania, and bipolar depression. Its
effectiveness in the treatment of substance use and anxi-
ety disorders has also been reported. It is reported that
quetiapine is increasingly abused, especially by patients
diagnosed with substance use disorders and by prisoners.
This observation, along with the lack of evidence that
quetiapine use causes abuse and dependence leaves clini-
cians with a dilemma concerning prescribing quetiapine
to treat these groups of patients. This dilemma contains
the risks of supporting the dependence of the patient,
and not using a drug that can be beneficial for the pa-
tient. This review aimed to examine published reports
on quetiapine abuse or dependence, and to present an
overview of this subject by discussing the possible mech-
anisms responsible. Additional studies that focus on pa-
tients with substance use disorders that are treated vol-
untarily or by court order, and controlled double-blind
studies involving people that have never used quetiapine
are needed.
American Psychiatric Association (1994) Mental Bozuklukların
Tanısal ve Sayımsal El Kitabı, Dördüncü Baskı (DSM-IV) (Çev. ed.: E
Köroğlu) Hekimler Yayın Birliği, Ankara, 1995.
Blum K, Braverman ER, Holder JM et al. (2000) Reward deficiency
syndrome: a biogenetic model for the diagnosis and treatment of
impulsive, addictive, and compulsive behaviors. J Psychoactive Drugs,
32:i-iv, 1-112.
Brown ES, Nejtek VA, Perantie DC et al. (2002) Quetiapine in bipolar
disorder and cocaine dependence. Bipolar Disorders, 4: 406-11.
Calabrese JR, Kech PE, Macfadden W et al. (2005) A randomized,
double-blind placebo-controlled trial of quetiapine in the treatment of
bipolar I or II depression. Am J Psychiatry, 162:1351–60.
Evren C, Karatepe HT, Aydın A et al. (2009) Alkol/Madde
bağımlılarında ketiyapinin etkisi ve kötüye kullanımı: Olgu serisi ve gözden
geçirme. Klinik Psikofarmakoloji Bülteni, 19: 148-54.
Goldstein JM (1999) Quetiapine fumarate (Seroquel): a new atypical
antipsychotic. Drugs Today (Barc), 35: 193-210.
Green AI, Zimmet SV, Strous RD et al. (1999) Clozapine for
comorbid substance use disorder and schizophrenia: Do patients with
schizophrenia have a higher reward deficiency syndrome that can be
ameliorated by clozapine? Harv Rev Psychiatry, 6: 287-96.
Green, B. (1999) Focus on quetiapine. Current Medical Research
Opinion, 15: 145.
Hanley MJ, Kenna GA (2008) Quetiapine: Treatment for substance
abuse and drug of abuse. Am J Health-Syst Pharm, 65: 611-8.
Hussain MZ, Waheed W, Hussain W (2005) Intravenous quetiapine
abuse.American Journal of Psychiatry, 162, 1755–1756.
Kapur S, Zipursky R, Jones C et al. (2000) A positron emission
tomography study of quetiapine in schizophrenia: a preliminary finding of
an antipsychotic effect with only transiently high dopamine D2 receptor
occupancy. Arch Gen Psychiatry, 57:553-9.
Kaya H, Dilbaz N, Okay T et al. (2009) Ketiyapin bağımlılık yapıyor
mu? Klinik Psikofarmakoloji Bülteni, 19: 32-6.
Keltner NL, Vance DE (2008) Incarcerated careand quetiapine abuse.
Perspectives in Psychiatric Care, 44: 202-6.
Kennedy A, Wood AE, Saxon AJ et al. (2008) Quetiapine for
the treatment of cocaine dependence: an open-label trial. J Clin
Psychopharmacol, 28:221-4.
Khantzian E (1985) The self-medication hypothesis of addictive
disorders. Am J Psychiatry, 142: 1259-64.
Martinotti G, Andreoli S, Nicola MD et al. (2008) Quetiapine
decreases alcohol consumption, craving and psychiatric symptoms in
dually diagnosed alcoholics. Hum Psychopharmacol Clin Exp, 23: 417-24.
McEvoy JP, Freudenreich O, Levin ED et al. (1995) Haloperidol
increases smoking in patients with schizophrenia. Psychopharmacology
(Berl), 119(1):124-6.
Morin AK (2007) Possible intranasal quetiapine misuse. American
Society of Health-System Pharmacists, 64, 723–5.
Murphy D, Bailey K, Stone M et al. (2008) Addictive potential of
quetiapine. Am J Psychiatry, 165(7):918.
Philip NS, Mello K, Carpenter LL et al. (2008) Patterns of quetiapine
use in psychiatric inpatients: an examination of off-label use. Ann Clin
Psychiatry, 20(1):15-20.
Pierre JM., Shnayder I, Wirshing DA et al. (2004) Intranasal quetiapine
abuse. American Journal of Psychiatry, 161:1718.
Pinkofsky HB, Hahn AM, Campbell FA et al. (2005) Reduction
of opioid-withdrawal symptoms with quetiapine. J Clin Psychiatry,
Pinta ER, Taylor RE (2007) Quetiapine addiction?AmericanJournal
of Psychiatry, 164(1): 174–5.
Potvin S, Kouassi E, Lipp O et al. (2008) Endogenous cannabinoids
in patients with schizophrenia and substance abuse disorder during
quetiapine therapy. J Psychopharmacol, 22(3): 262-9.
Riedel M, Müller N, Strassnig M et al. (2007) Quetiapine in the
treatment of schizophrenia and releated disorders. Neuropsychiatr Dis
Treat, 3(2):219-35.
Reeves, RR, Brister JC (2007) Additional evidence of the abuse
potential of quetiapine. Southern Medical Journal, 100: 834–6.
Robert S, Hamner MB, Kose S et al. (2005) Quetiapine improves sleep
disturbances in combat veterans with PTSD. J Clin Psychopharmacol
25(4): 387-8.
Rowe DL (2007) Off-label prescription of quetiapine in psychiatric
disorders. Expert Rev Neurother, 7(7):841-52.
Sattar PS, Bhatia SC, Petty F (2004) Potential benefits of quetiapine in
the treatment of substance dependence disorders. J Psychiatry Neurosci,
Volkow ND, Fowler JS, Wang GJ et al. (2002) Role of dopamine,
the frontal cortex and memory circuits in drug addiction: insight from
imaging studies. Neurobiol Learn Mem, 78:610-24.
Waters BM, Joshi KG (2007) Intravenous quetiapine-cocaine use (“Q
ball”). American Journal of Psychiatry, 164, 173–4.
... [7] A series of case reports of AA abuse was reported in literature more than a decade ago, [8,9] and several studies documented quetiapine as the most commonly abused AA. [10][11][12][13] Although off-label prescribing in psychiatry is a common practice, changing trends in AA off-label use and the associated risks need to be scrutinized due to a potential correlation between previous substance abuse history (i.e., schizophrenia or bipolar disorder) and likelihood of misusing and abusing AAs. [14,15] Use of AAs in patients with substance abuse has been noted where drug-seeking behaviors were observed in correctional facility settings. [10] Quetiapine abuse may be more prevalent among prisoners since commonly abused drugs are not readily available due to limited pharmaceutical formulary. ...
... [18][19][20][21][22] Quetiapine decreased psychiatric symptoms such as sleeplessness and anxiety for alcoholic patients with comorbid conditions such as bipolar disorder or schizoaffective disorder when patients were provided with 300-800 mg/day for 16 weeks following detoxification treatment. [14] One possible speculation is that quetiapine alleviated mood symptoms and anxiety associated with withdrawal symptoms. ...
... Dopamine sensitivity in schizophrenic patients was found to make them more susceptible to the rewarding effect of the substance. [14] QuetIapIne off-label use ...
Full-text available
Recent case reports in medical literatures suggest that more and more second-generation atypical antipsychotics (AAs) have been prescribed for off-label use; quetiapine (Brand name: Seroquel®) showed increase in its trend for off-label use. Little is known about the reasons behind this trend, although historical sedative and hypnotic prescription patterns suggest that despite relatively superior safety profiles of quetiapine (especially for movement disorders), it may be used for treating substance abuse disorder. In addition, recent studies have shown a strong potential for misuse and abuse (MUA) of quetiapine beyond Food and Drug Administration-approved indications. This includes drug-seeking behaviors, such as feigning symptoms, motivated by quetiapine and use of quetiapine in conjunction with alcohol. Quetiapine appears to be the most documented AA with street values bartered illicitly on the street. A recent report from the Drug Abuse Warning Network has shown a high prevalence of quetiapine-related emergency department visits involving MUA. Several other case studies have found that quetiapine causes seeking behaviors observed in substance use disorder. In fact, the majority of quetiapine MUA involved patients diagnosed with substance use disorder. In the absence of a definitive mechanism of action of quetiapine's reinforcing properties, it is imperative to gather robust evidence to support or refute increasing off-label use of AAs.
... 3 Quetiapine has been used, with varying degrees of success, to aid in treating withdrawal symptoms from abused substances (ie, alcohol, cocaine, benzodiazepines, opioids) and increasing abstinence. [9][10][11][12][13][14][15][16][17][18][19][20][21] These studies did not establish whether quetiapine works by improving comorbid Emergency Department Visits Involving Misuse and Abuse of the Antipsychotic Quetiapine: Results from the Drug Abuse Warning Network (DAWN) psychiatric conditions or by directly reducing craving. 3 Quetiapine has been used to treat insomnia in patients in early recovery from alcohol dependence but with inconsistent results. ...
... 28,29 Numerous case reports and several more systematic studies have shown that the problem of quetiapine abuse is not confined to penal populations and occurs in other settings and among other populations, such as psychiatric patients -both hospitalized and outpatient -and patients attending drug treatment clinics. 11,12,28,[30][31][32][33][34][35][36][37][38][39][40][41] Anecdotal evidence exists that patients attending emergency facilities and clinics demand quetiapine 31 for malingering or fabricated psychotic symptoms, such as hearing voices. 24 Cubala and Springer 32 reviewed 25 case reports of quetiapine use and abuse among psychiatric patients, published from 1966 to 2012, and identified the main users as males in their middle 30s; about half of users had a history of substance abuse or dependence. ...
Full-text available
Case reports in medical literature suggest that the atypical antipsychotic quetiapine, a medication not previously considered to have abuse potential, is now being subject to misuse and abuse (MUA; ie, taken when not prescribed for them or used in a way other than instructed by their health professional). Here we present systematic, nationally representative data from the 2005 to 2011 Drug Abuse Warning Network (DAWN) for prevalence of emergency department (ED) visits among the U.S. general population involving quetiapine and related to MUA, suicide attempts, and adverse reactions. Nationally, quetiapine-related ED visits increased 90% between 2005 and 2011, from 35,581 ED visits to 67,497. DAWN data indicate that when used without medical supervision for recreational/self-medication purposes, quetiapine poses health risks for its users, especially among polydrug users and women. These findings suggest that the medical and public health communities should increase vigilance concerning this drug and its potential for MUA.
... It is estimated that 60-70% of patients treated with quetiapine receives that drug for indications other than for which it is registered [1][2][3]. Very often quetiapine is used in the treatment of various disorders due to psychoactive substance use, including the treatment of affective and psychotic disorders associated with comorbid abuse or addiction to them [4,5]. ...
... The latter is intravenously administered combination of quetiapine and cocaine, where quetiapine is a replacement for heroin in another, often used mixture called "speedball". In Turkey one of the street names used for quetiapine is "yellow lake" [4]. In addition, the trade name of one of the quetiapine formulations in the U.S. is mentioned in the rap song along with other substances that cause addiction [31]. ...
Quetiapine is an atypical antipsychotic agent, frequently used in psychiatry, often for symptomatic treatment against a number of mental disorders differing from the registration indications. One of the use is to soothe the clinical conditions caused by the use of various psychoactive substances. The paper presents and discusses the reports of quetiapine misuse, abuse, and even mental addiction, as well as symptoms similar to the so-called discontinuation syndrome, often mixed with withdrawal syndrome occurring in the course of addiction. Most reports concern males, and especially those with a history of other psychoactive substance abuse, and personality disorders, often in conflict with the law. Therefore, clinicians should be cautious when prescribing quetiapine to such patients. The article discusses potential mechanisms responsible for quetiapine abuse. This is probably related to its sedative and anxiolytic activity which results in the frequent use with stimulants. Also, high affinity for the H-1 receptor, as antihistamines agents causes rewarding action.
... 34 Quetiapine affinity for 5-HT 2A receptors is much stronger than its affinity for D 2 receptor, consequently, it is thought to cause fewer extrapyramidal side effects. 35 Quetiapine increased BMI slightly but significantly in our patients. Other workers showed minimal weight gain by quetiapine; 13, 36, 37 however, weight gain by quetiapine was still higher than risperidone and sertindole. ...
Full-text available
Objectives: To find the effect of quetiapine on lipid peroxidation and serum total antioxidant status (TAS) in schizophrenic patients. Patients and methods: The subjects comprised 27 schizophrenic patients and 27 healthy volunteers. Clinical symptoms for the patients were assessed in Brief Individual Psychiatry Rating Scale (BPRS) items. The patients were treated with quetiapine (200-500 mg/day) orally for 8 weeks then reevaluated after the treatment. Blood samples from the patients were taken before and after quetiapine treatments. Other blood samples were taken from healthy subjects as a control group. Serum was obtained and analyzed for malondialdehyde (MDA) and TAS. Results: Base time and after 8 weeks of quetiapine treatment showed a significant decrease in BPRS score in the schizophrenic patients. Serum MDA was significantly higher in the schizophrenic patients (difference = 124.1% of control) than controls. The parameter decreased significantly after quetiapine treatment by 16.9% compared with before treatment values. Serum TAS, in the schizophrenic patients, was significantly lower (38.4%) than controls. Quetiapine increased serum TAS significantly by 21.1%. Quetiapine treatment significantly increased body mass index (BMI) by 2.9%. Conclusion: Quetiapine depressed lipid peroxidation, and raised serum TAS in schizophrenic patients. The change in these parameters by quetiapine may play a role in its therapeutic activit.
... In some cases QTP is combined with other substances, such as cocaine or marihuana, to increase sedation. It is believed that the anxiolytic sedative action of the drug lies behind this kind of abuse [80]. ...
Full-text available
Citation: Ramadhan Oruch., et al. "Quetiapine: An Objective Evaluation of Pharmacology, Clinical Uses and Intoxication". EC Pharmacology and Toxicology 8.4 (2020): 01-26. Abstract Quetiapine is an antipsychotic drug that belongs to the group of nonconventional agents. Mainly used to treat schizophrenia, bipolar depressive disorder, and exacerbations of manic and depressive episodes of this condition. It is also used to prevent these episodes of exacerbation, beside its many off-label uses. Atypical antipsychotics treat negative symptoms of psychosis without causing extra sedation, and help schizophrenics to integrate into society and, in addition, to remove unwanted extrapyramidal symptoms that conventional agents are known to exert. Unfortunately, these agents, including quetiapine, have other drawbacks the most serious of which are those associated with the disease spectrum of metabolic syndrome and, furthermore, the many interactions quetiapine may be involved in with other drugs in cases of polypharmacy. This review gives an update on quetiapine and provides a guideline to psychiatric caregivers, and importantly, undergraduates of medicine and pharmacy students on clinical uses (both dedicated and off-label), pharmacology, pharmacopeia, and intoxication that might occur following its use, and how to treat such a condition.
... docid/patch_f/7598; Goldstein, 1999;Reeves and Brister, 2007;Riedel et al., 2007). Although this profile of effects, antipsychotic/antidepressant with 5-HT and dopamine (DA) receptor antagonism, would not suggest abuse potential of quetiapine, there are multiple case reports of quetiapine abuse via multiple routes of administration (e.g., Morin, 2007;Erdo gan, 2010). For example, oral abuse of quetiapine has been documented in three separate case reports ( Reeves and Brister, 2007). ...
There are several case reports of non-medicinal quetiapine abuse yet there are very limited preclinical studies investigating quetiapine self-administration. The goal of this study was to investigate the reinforcing effects of quetiapine alone and in combination with intravenous cocaine in monkeys. In Experiment 1, cocaine-experienced female monkeys (N=4) responded under a fixed-ratio (FR) 30 schedule of food reinforcement (1.0-g banana-flavored pellets) and, when responding was stable, quetiapine (0.003-0.1 mg/kg per injection) or saline was substituted for a minimum of 5 sessions; there was a return to food-maintained responding between doses. Next, monkeys were treated with quetiapine (25 mg, p.o., b.i.d.) for approximately 30 days and then the quetiapine dose-response curve was redetermined. In Experiment 2, male monkeys (N=6) self-administered cocaine under a concurrent FR schedule with food reinforcement (three, food pellets) as the alternative to cocaine (0.003-0.3 mg/kg/injection) presentation. Once choice responding was stable, the effects of adding quetiapine (0.03 or 0.1 mg/kg/injection) to the cocaine solution were examined. In Experiment 1, quetiapine did not function as a reinforcer and chronic quetiapine treatment did not alter these effects. In Experiment 2, cocaine choice increased in a dose-dependent fashion. The addition of quetiapine to cocaine resulted in increases in low-dose cocaine choice and number of cocaine injections in four monkeys, while not affecting high-dose cocaine preference. Thus, while quetiapine alone does not have abuse potential, there was evidence of enhancement of the reinforcing potency of cocaine. These results suggest that the use of quetiapine in cocaine-addicted patients should be monitored.
... There are no controlled studies on quetiapine dependence in the literature and it remains unknown whether or not quetiapine causes dependence. (17) Till now, there are no RCTs studying the role of Quetiapine in opioid craving or preventing relapse. Currently, Naltrexone is the only drug being used for relapse prevention but its role is limited by its cost and efficacy. ...
Full-text available
AIM: The aim of the study is to compare quetiapine with placebo along with oral naltr exone in the treatment of opioid dependent patients. We conducted the study as opioid dependence is steadily increasing in this area and more research is needed to prevent relapse after opioid detoxification. SETTINGS AND DESIGN: It is a double blind place bo controlled , randomized study that was conducted in department of psychiatry, de addiction unit (Sri Guru Ram Das Institute of Medical Sciences & Research, Sri Amritsar) over one year time period. All the patients who were taken in the study had a confi rmed diagnosis of opioid dependence as per ICD 10 criteria. MATERIAL AND METHOD: It is a double blind, placebo controlled, randomized study. A total of 217 subjects were admitted over year, out of which 164 were screened as 53 subjects refused to participa te. Out of 164 randomization of 152 patient was done and two groups (1&2) were made. . During detoxification, opioids were given to both groups and stopped after 1 - 2 weeks. Then all patients were started on Naltrexone 50 mg/day. Group 1 (n=73) received nal trexone (50mg/day) plus quetiapine (50 - 200mg/day), while group 2 (n=79) received naltrexone (50mg/day) plus placebo (multivitamin) for next 26 weeks. Our primary efficacy measures were relapse rate and percent days of abstinence . Two groups were compared w ith the help of percentage method and independent t test done. RESULTS: Relapse rate in placebo group was almost twice to that of Quetiapine group. In group 1, 24 subjects (32.87%) had relapsed by the end of 6 months as compared to 56 subjects (70.88%) in group 2. Percent days of abstinence in Quetiapine group were significantly higher as compared to placebo group. DISCUSSION: Our study shows significant advantages in using Quetiapine along with Naltrexone to decrease relapse rate and increase percent days of abstinence after inpatient detoxification.
... On the other hand, patients suffering from attention deficit hyperactivity disorder (ADHD) and some other neuropsychiatric disorders commonly show deficits in PFC functions (Brennan and Arnsten, 2008;Casey et al., 1997). Many neuropsychiatric diseases are related to the loss or malformation of dendritic spine (Calabrese et al., 2006) and new evidence show the benefits targeting some adrenergic receptors may have in cases of depression (Erdogan, 2010) (such as the drug Mirtazapine (Kasper et al., 1997)) and anxiety. Indeed, whereas the deficiencies of serotonergic system are believed to be involved in anxiety and depression (Consoli et al., 2007) a decreased central dopaminergic and/or noradrenergic transmission is likely involved in the pathology of depression (Guiard et al., 2008) which not only puts more light on the bridges linking neural imbalances and psychiatric disorders but also indicate potential therapies. ...
Full-text available
Adrenergic receptors belong to the family of the G protein coupled receptors that represent important targets in the modern pharmacotherapies. Studies on different physiological and pathophysiological properties of the adrenergic system have led to novel evidences and theories that suggest novel possible targeting of such system in a variety of pathologies and disorders, even beyond the classical known therapeutic possibilities. Herein, those advances have been illustrated with selected concepts and different examples. Furthermore, we illustrated the applications and the therapeutic implications that such findings and advances might have in the contexts of experimental pharmacology, therapeutics and clinic. We hope that the content of this work will guide researches devoted to the adrenergic aspects that combine neurosciences with pharmacology.
Full-text available
Background Compared with Risperidone, Quetiapine’s effectiveness and safety on treating alcohol-induced mental disorder is still unclear. Objective To investigate the clinical effectiveness and safety of Quetiapine on treating alcohol-induced mental disorder. Methods One hundred and forty-eight patients with alcohol-induced mental disorder were divided into the experimental group (75 patients) and the control group (73 patients) by the treatments they received. The patients in the experimental group were treated with Quetiapine by taking it three times per day orally. The mean (sd) maintenance dose was 151.2(27.3) mg/d, and the treatment cycle was 6 weeks. Patients in the control group received Risperidone once per day orally with a mean (sd) maintenance dose being 2.3(0.9) mg/d, and the treatment cycle was 6 weeks as well. The PANSS scale was used to assess patients’ before and after treatment. The researchers also observed any adverse reactions in both treatment strategies and evaluated the effectiveness and safety of both treatment strategies. Results The mean (sd) PANSS scale score of the experimental group after two weeks of treatment was 71.9 (10.2), which was clearly better than the mean (sd) score before treatment (82.6 [11.4]), and was significantly better than the control group’s mean (sd) score after two weeks (76.5[12.8]). Also, the experimental group’s scores after 4 weeks of treatment and 6 weeks of treatment were significantly better than the control group. The experimental group’s efficacy rate (94.7%) was higher than the control group’s (90.4%); the cure rate of the experimental group (33.3%) was higher than that of the control group (24.7%), and the difference was statistically significant. The rates of adverse reactions in the experimental and control groups were 13.3% and 19.2% respectively, and they were significantly different from each other. Conclusion Treating alcohol-induced mental disorder with Quetiapine is more effective than treating it with Risperidone. Quetiapine can improve patients’ symptoms quickly, and lower the chance of adverse reactions. It is effective and safe.
Full-text available
Quetiapine is an atypical antipsychotic drug, which has been found to be effective in the treatment of schizophrenia, bipolar disorder, and related disorders. Recent studies report the effectiveness of quetiapine among patients with substance use disorders both as a single disorder and as a comorbid disorder with the aforementioned disorders. Case reports have accumulated evidence suggesting that quetiapine may also be abused. In this report we presented 3 cases of inpatients at an addiction treatment center with the suspicion of quetiapine abuse. We also reviewed the literature concerning the effectiveness and abuse potentiality of quetiapine in substance dependent patients.
Full-text available
ÖZET: Alkol/madde ba¤›ml›lar›nda ketiapinin etkisi ve kötüye kullan›m›: Olgu serisi ve gözden ge- çirme Ketiapin atipik antipsikotik olarak deerlendirilen ve flizofrenik bozukluk, bipolar bozukluk ve iliflkili durumlar›n tedavisinde etkinlii kan›tlanm›fl bir ilaçt›r. Son dönemde yap›lan çal›flmalarda, hem bu bozukluklarla komorbid hem de tek bafl›na olan alkol/madde kullan›m bozukluunda ketiapinin etkinliinden bahsedilmektedir. Ancak ayn› zamanda ketiapin kötüye kullan›m›n› düflündüren vaka bildirimleri de giderek artmaktad›r. Bu yaz›da bir ba¤›ml›l›k merkezinde ayn› hafta içinde yatarak tedavi olan ve ketiapini kötüye kulland›klar› flüphesi oluflan 3 olgu sunulmufltur. Ayr›ca bu vakalar dorultusunda ketiapinin alkol/madde ba¤›ml›l›¤›nda hem etkinlii hem de kötüye kullan›m› ile ilgili literatür gözden geçirilmifltir. Anahtar sözcükler: Alkol ba¤›ml›l›¤›, madde ba¤›ml›l›¤›, ketiapin, kötüye kullan›m Klinik Psikofarmakoloji Bülteni 2009;19:148-154 ABSTRACT: The effect of quetiapine on alcohol/drug dependents and its abuse: A case series and literature review Quetiapine is an atypical antipsychotic drug, which has been found to be effective in the treatment of schizophrenia, bipolar disorder, and related disorders. Recent studies report the effectiveness of quetiapine among patients with substance use disorders both as a single disorder and as a comorbid disorder with the aforementioned disorders. Case reports have accumulated evidence suggesting that quetiapine may also be abused. In this report we presented 3 cases of inpatients at an addiction treatment center with the suspicion of quetiapine abuse. We also reviewed the literature concerning the effectiveness and abuse potentiality of quetiapine in substance dependent patients.
Full-text available
"The reward cascade" is the release of serotonin, which in turn at the hypothalamus stimulates enkephalin, which in turn inhibits gamma-aminobutyric acid (GABA) at the substantia nigra, which in turn fine tunes the amount of dopamine (DA) released at the nucleus accumbens or "reward site." When DA is released into the synapse, it stimulates a number of DA receptors which results in increased feelings of well-being and stress reduction. It is suggested that when there is a dysfunction in the brain reward cascade, especially in the DA system causing a hypodopaminergic trait, the brain of that person requires a DA fix to feel good. This trait leads to multiple drug-seeking behavior. This is so because alcohol, cocaine, heroin, marijuana, nicotine, and glucose all cause activation and neuronal release of brain DA, which could heal the abnormal cravings. The lack of D₂ receptors causes individuals to have a high risk of multiple addictive, impulsive and compulsive behavioral propensities, such as severe alcoholism, cocaine, heroin, marijuana and nicotine use, glucose bingeing, pathological gambling, sex addiction, attention deficit hyperactivity disorder (ADHD), Tourette's syndrome, autism, chronic violence, posttraumatic stress disorder (PTSD), schizoid/avoidant cluster, conduct disorder, and antisocial behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Full-text available
Quetiapine was developed in 1985 by scientists at AstraZeneca (formerly Zeneca) Pharmaceuticals. It received official US Food and Drug Administration approval in September 1997 and approval in Germany in 2000. Since then, quetiapine has been used in the treatment of severe mental illness in approximately 70 countries including Canada, most Western European countries, and Japan. Quetiapine is a dibenzothiazepine derivative with a relatively broad receptor binding profile. It has major affinity to cerebral serotonergic (5HT(2A)), histaminergic (H1), and dopaminergic D(1) and D(2) receptors, moderate affinity to alpha(1)- und alpha(2)-adrenergic receptors, and minor affinity to muscarinergic M1 receptors; it demonstrates a substantial selectivity for the limbic system. This receptor occupancy profile with relatively higher affinity for the 5HT(2A) receptor compared with the D(2) receptor is in part responsible for the antipsychotic characteristics and low incidence of extrapyramidal side-effects of quetiapine. The efficacy of quetiapine in reducing positive and negative symptoms of schizophrenia has been proven in several clinical trials with placebo-controlled comparators. Quetiapine has also demonstrated robust efficacy for treatment of cognitive, anxious-depressive, and aggressive symptoms in schizophrenia. Long-term trials show sustained tolerability for a broad spectrum of symptoms. Quetiapine has also proven efficacy and tolerability in the treatment of moderate to severe manic episodes, and in the treatment of juveniles with oppositional-defiant or conduct disorders, and in the geriatric dementia population. Recent data indicate that quetiapine may also be effective in the treatment of bipolar depressive symptoms without increasing the risk of triggering manic episodes, and in borderline personality disorder. In comparison with other antipsychotics, quetiapine has a favorable side-effect profile. In clinical trials only small insignificant prolongations of the QT interval were observed. Weight-gain liabilities and new-onset metabolic side-effects occupy a middle-ground among newer antipsychotics. As a result of its good efficacy and tolerability profile quetiapine has become well established in the treatment of schizophrenia and manic episodes.
Full-text available
Quetiapine is a new atypical antipsychotic medication. As such, relatively little has been published regarding its in vivo effects at the dopamine type 2 (D2) and serotonin type 2a (5-HT2a) receptor systems. The following study was undertaken to explore these effects across the clinical dose range and relate this information to its clinical profile. Twelve patients with schizophrenia were randomly assigned to doses of 150 to 600 mg/d (n=3, at 150, 300, 450, and 600 mg/d) of quetiapine. After 3 weeks of treatment, D2 and 5-HT2a occupancy were measured using positron emission tomography (PET) imaging, 12 to 14 hours after the last dose. Clinical efficacy and adverse effect ratings were obtained at baseline, at the time of PET scanning, and at 12 weeks. Two additional patients were included to examine the effects of the drug 2 to 3 hours after last dose. Quetiapine was an effective antipsychotic and improved the extrapyramidal symptoms and prolactin level elevation noted at baseline. It achieved these results with minimal (0%-27%) D2 occupancy 12 hours after the last dose. Study of the additional subjects revealed that quetiapine does give rise to transiently high (58%-64%) D2 occupancy 2 to 3 hours after a single dose that then decreases to minimal levels in 12 hours. Quetiapine shows a transiently high D2 occupancy, which decreases to very low levels by the end of the dosing interval. Quetiapine's low D2 occupancy can explain its freedom from extrapyramidal symptoms and prolactin level elevation. The data suggest that transient D2 occupancy may be sufficient for its antipsychotic effect. Future studies controlling for nonpharmacological effects as well as activities on other receptors will be necessary to confirm this suggestion.
Ten patients with schizophrenia participated in 120-min free-smoking sessions when actively psychotic and free of antipsychotic medications, and again after the initiation of haloperidol treatment. During these free-smoking sessions they had access to cigarettes ad libitum. Their expired air carbon monoxide (CO) and plasma nicotine and cotinine levels were measured at the end of the 120-min free-smoking sessions. These patients smoked more after starting haloperidol treatment, relative to their baseline rate of smoking when free of antipsychotic medications, as evidenced by significantly higher expired CO and plasma nicotine levels.
Alcohol and other drugs of abuse are commonly used by persons with schizophrenia and contribute to the overall morbidity of the disorder. Standard, or typical, antipsychotic drugs do not limit such substance use and may even render it more likely. However, preliminary data from our group and others suggest that the atypical antipsychotic clozapine may decrease substance use in this population. While recognizing the likelihood that substance use decreases negative symptoms (as well as extrapyramidal symptoms) in persons with schizophrenia, we hypothesize that the biological basis of substance use relates to a "reward-deficiency syndrome" secondary to dysfunctional dopamine-mediated mesocorticolimbic neurons in these individuals. We further suggest that clozapine's beneficial effect in patients with comorbid schizophrenia and substance use disorders may relate to its presumed ability to ameliorate the deficits in both the mesocortical and mesolimbic dopaminergic neuronal projections through its various actions on dopaminergic, serotonergic, and particularly noradrenergic neurons.
Quetiapine fumarate is a novel dibenzothiazepine antipsychotic developed by Zeneca. It is marketed under the trade name 'Seroquel'. Quetiapine is well tolerated and clinically effective in the treatment of schizophrenia. The initial hope of investigators was that quetiapine would have antipsychotic potential and that it might share some of the properties of clozapine without its toxicity to white blood cells. The effective dosage range is usually 300-450 mg/day split into two doses. The dose is titrated upwards from 25 mg twice daily from day 1 to 300 mg/day on day 4. Elderly patients or patients with liver problems should be started on lower doses. It is both superior to placebo and comparable to haloperidol in reducing positive symptoms at doses ranging from 150 mg/day to 750 mg/day, and is an effective treatment for negative symptoms. Somnolence is the most common adverse event. Abnormalities of the QT interval on ECG appear very infrequently and there is no need for a baseline ECG or blood pressure monitoring, as used to be the case with sertindole. There is no need for haematological monitoring as with clozapine. Quetiapine, across the full dosage range, is associated with no greater extrapyramidal symptoms than placebo. Quetiapine's general efficacy and side-effect profile suggest that, unless there are unforeseen post-marketing complications, it deserves a major place in the initial and long-term management of schizophreniform disorders.