Quetiapine alone and added to a mood stabilizer for serious mood disorders

Background. Use of antipsychotic medication intermittently or over the long term may be necessary in treating patients with bipolar disorder whose sym ptoms have responded suboptimally to standard mood-stabilizing agents. Quet iapine fumarate is an effective novel antipsychotic with mixed serotonergic (5-HT2) and dopaminergic (D-2) activity. This is an open-label, 12-week pr ospective study to assess the efficacy and tolerability of quetiapine in th e treatment of patients with bipolar and schizoaffective disorder who were suboptimally responsive to mood stabilizers alone. Method: Participants in the study were inpatients or outpatients with a DSM -IV diagnosis of bipolar or schizoaffective disorder. Baseline psychopathol ogy was evaluated with the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale (YMRS), and the Hamilton Rating Scale for Depression (H AM-D). Involuntary movements were rated with the Simpson-Angus Neurologic R ating Scale. Quetiapine was added on an open-label basis and increased to o ptimum clinical dosage. Psychopathology and Abnormal Involuntary Movement S cale ratings were repeated weekly for the first 4 weeks and then again at w eeks 8 and 12. Results: Ten individuals with bipolar disorder and 10 with schizoaffective disorder received quetiapine therapy. Overall, patients improved, with sign ificant improvement in BPRS (p < .001), YMRS (p =.043), and HAM-D scores (p =.002). Simpson-Angus score also significantly decreased (p =.02). Overall , quetiapine was well tolerated by patients in this group with serious mood disorders. The mean SD quetiapine dose was 202.9 +/- 124.3 mg/day (range, 50-400 mg/day). Mean weight gain was 10.9 lb (4.9 kg). Conclusion: Although limited by its small size, open-label design, and rela tive gender homogeneity, this study suggests that quetiapine therapy may be useful in the treatment of individuals with serious mood disorders who are suboptimally responsive to mood stabilizers alone. These preliminary findi ngs should be explored in larger, controlled trials.