Quetiapine as add-on treatment for bipolar I disorder: efficacy in preventing relapse of depressive episodes
Tóm tắt
To assess the long-term response to add-on quetiapine therapy in patients with bipolar I disorder who were not adequately responding to standard medications. Outpatients with bipolar I disorder (DSM-IV-TR) responding inadequately to standard treatment were observed before and after the addition of quetiapine. Symptom severity was evaluated using the Clinical Global Impressions scale for Bipolar Disorder (CGI-BP) each month. Relapses included hospitalization, treatment in a day hospital or clinic, scores ≥ 1 point higher than previous CGI-BP scores and/or upward titration of quetiapine or other medications. Sixty-one patients (age range of 18–68 years) were observed prospectively for an average of 7.5 months (range 3–18 months) prior to addition of quetiapine and subsequently followed for an average of 15.7 months (range 6–42 months). The final mean quetiapine dose was 537.1 ± 91.7 mg/d. Prior to quetiapine addition, an annual relapse rate of 2.09 episodes was recorded, relating to 0.94 depressive and 1.15 manic or mixed episodes. Following quetiapine addition, annual relapse rates were reduced to 0.61 episodes, representing 0.14 depressive and 0.46 manic or mixed episodes. Compared with the period of add-on quetiapine treatment, the relative risk of relapse prior to quetiapine therapy was 3.4 for all episodes (χ2 = 24.8, P < 0.001), 6.7 for depressive episodes (χ2 = 24.7, P < 0.001), and 2.5 for manic or mixed episodes (χ2 = 9.0, P < 0.05). This naturalistic follow-up study provides preliminary evidence for the efficacy of long-term add-on quetiapine treatment in the prevention of relapses of manic or mixed and depressive episodes of bipolar I disorder, and particularly in the prevention of depressive episodes.
Tài liệu tham khảo
Carta MG, Angst J: Epidemiological and clinical aspects of bipolar disorders: controversies or a common need to redefine the aims and methodological aspects of surveys. Clin Pract Epidemol Ment Health. 2005, 1: 4-10.1186/1745-0179-1-4.
American Psychiatric Association: Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry. 2002, 159: 1-50. 10.1176/appi.ajp.159.1.1.
Vieta E, Mullen J, Brecher M, Paulsson B, Jones M: Quetiapine monotherapy for mania associated with bipolar disorder: combined analysis of two international, double-blind, randomized, placebo-controlled studies. Curr Med Res Opin. 2005, 21: 923-934. 10.1185/030079905X46340.
Sachs G, Chengappa K, Suppes T, et al: Quetiapine with lithium or divalproex for the treatment of bipolar mania: a randomized, double-blind, placebo-controlled study. Bipolar Disord. 2004, 6: 213-223. 10.1111/j.1399-5618.2004.00115.x.
Calabrese JR, Keck PE, Macfadden W, et al: A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry. 2005, 162: 1351-1360. 10.1176/appi.ajp.162.7.1351.
Yatham LN, Paulsson B, Mullen J, Vågerö M: Quetiapine versus placebo in combination with lithium or divalproex for the treatment of bipolar mania. J Clin Psychopharmacol. 2004, 24: 599-606. 10.1097/01.jcp.0000144887.66319.2f.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). 2000, Washington, DC: American Psychiatric Association
Spearing MK, Post RM, Leverich GS, Brandt D, Nolen W: Modification of the Clinical Global Impression (CGI) Scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res. 1997, 73: 159-171. 10.1016/S0165-1781(97)00123-6.
Miettinen O: Confounding and effect-modification. Am J Epidemiol. 1974, 100: 350-353.
Hardoy MC, Garofalo A, Carpiniello B, Calabrese JR, Carta MG: Combination quetiapine therapy in the long-term treatment of patients with bipolar I disorder. Clin Pract Epidemiol Ment Health. 2005, 1: 7-10.1186/1745-0179-1-7.
Milev R, Abraham G, Zaheer J: Add-on quetiapine for bipolar depression: a 12-month open-label trial. Can J Psychiatry. 2006, 51 (8): 523-30.
Vieta E, Calabrese JR, Goikolea JM, Raines S, Macfadden W, BOLDER Study Group: Quetiapine monotherapy in the treatment of patients with bipolar I or II depression and a rapid-cycling disease course: a randomized, double-blind, placebo-controlled study. Bipolar Disord. 2007, 9 (4): 413-25. 10.1111/j.1399-5618.2007.00479.x.
Goldberg JF, Kelley ME, Rosenquist KJ, Hsu DJ, Filkowski MM, Nassir Ghaemi SJ: Effectiveness of quetiapine in rapid cycling bipolar disorder: A preliminary study. J Affect Disord. 2007, 4-