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PSYCHIATRY

Safety and Efficacy of Quetiapine in Bipolar Depression

Pharmacy Practice Resident, Englewood Hospital and Medical Center, Englewood, NJ

Benjamin Chavez, PharmD BCPP

Clinical Assistant Professor, Rutgers, State University of New Jersey

Reprints: Dr. Chavez, Rutgers, State University of New Jersey, 160 Frelinghuysen Rd., Piscataway, NJ 08854, fax 732/923-7810, bchavez{at}rci.rutgers.edu

OBJECTIVE: To review the clinical data investigating the efficacy and safety of quetiapine in bipolar depression.

DATA SOURCES: Searches of MEDLINE and PubMed (1977–July 2009) were conducted using the key words quetiapine and bipolar depression. The references of literature found were cross-referenced. The pharmaceutical company that produces quetiapine was contacted to obtain the posters for the EMBOLDEN I and EMBOLDEN II trials.

STUDY SELECTION AND DATA EXTRACTION: Only double-blind, placebo-controlled trials were included for review, as well as any subanalyses of the literature that matched this criterion.

DATA SYNTHESIS: There was a total of 5 double-blind, placebo-controlled trials and 5 subanalyses reviewed. The results of these data demonstrated quetiapine's efficacy in the treatment of depressive phases of bipolar disorder, including statistically significant improvement in the Montgomery-Åsberg Depression Rating Scale (MADRS). In the trials reviewed in this article, the change in MADRS scores ranged from –15.4 to –16.94 within the quetiapine groups, and from –10.26 to –11.93 in the placebo groups. There were also statistically significant improvements in the Hamilton Anxiety Rating Scale, the Short Form of the Quality of Life Enjoyment and Satisfaction Questionnaire, the Pittsburgh Sleep Quality Index, and the Sheehan Disability Scale. All of these trials had a duration of 8 weeks and therefore cannot be applied to the long-term use of quetiapine in bipolar depression. The most common adverse events were sedation, somnolence, and dry mouth. The overall dropout rates for the trials reviewed ranged from 24% to 47%.

CONCLUSIONS: Based on the literature reviewed here, quetiapine appears to be a safe and efficacious short-term treatment option for bipolar depression. Patients with bipolar type I showed greater improvement on the MADRS than those with bipolar type II. Patients with a rapid-cycling disease course showed an improvement in depressive symptoms, regardless of bipolar type.

Key Words: bipolar depression, bipolar disorder, quetiapine

Published Online, October 6, 2009. www.theannals.com, DOI 10.1345/aph.1M193

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-09-028-H01-P