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In This Article
   Introduction
   Case history
   Discussion
   Conclusion
   References

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CASE REPORT
Year : 2006  |  Volume : 38  |  Issue : 5  |  Page : 370-371
 

Quetiapine monotherapy in long-term mood stabilisation


Department of Psychiatry, Mood and Anxiety Disorders Unit, Echallens 9, 1004 Lausanne, Switzerland

Correspondence Address:
Y Khazaal
Department of Psychiatry, Mood and Anxiety Disorders Unit, Echallens 9, 1004 Lausanne
Switzerland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7613.27713

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How to cite this article:
Khazaal Y. Quetiapine monotherapy in long-term mood stabilisation. Indian J Pharmacol 2006;38:370-1

How to cite this URL:
Khazaal Y. Quetiapine monotherapy in long-term mood stabilisation. Indian J Pharmacol [serial online] 2006 [cited 2020 Feb 27];38:370-1. Available from: http://www.ijp-online.com/text.asp?2006/38/5/370/27713



  Introduction Top


Quetiapine, an atypical antipsychotic agent, has antagonistic properties towards various neurotransmitter receptor sites, including serotonin (5HT 1A ; 5HT 2A ), dopamine (D 1 ; D 2 ), histamine (H1) and adrenaline (Alpha 1; Alpha 2). Quetiapine has a lower affinity for D 2 receptors than dopamine itself, leading to an intermittent D 2 blockade, and may contribute to the excellent tolerability profile of this substance. It was hypothesised that quetiapine may act on depression, through its antagonism of 5-HT 2A receptors, and on mania through its antagonism of D 2 receptors.[1] Quetiapine was found to be effective in the treatment of acute bipolar mania, both as monotherapy and in combination with other mood stabilisers,[2] as well as monotherapy in acute bipolar depression.[3] Despite this, to our knowledge, there are very few published experiences with regard to long-term quetiapine monotherapy in schizoaffective disorder, bipolar type (SAD) and bipolar disorder (BPD).[4]


  Case history Top


Ms A, 36 years old, had a 14-year history of SAD with 28 hospitalisations for affective or psychotic episodes (16 manic, 4 depressive episodes, 4 mixed and 4 psychotic episodes). She had no stable accommodation for over 6 months and no stable, significant personal relationships or work during her adult life. She had previously been treated with a number of antipsychotic drugs and mood stabilisers, including lithium, valproate and carbamazepine. Ms A had poor adherence to treatments due to side effects (i.e. loss of hair with valproate, weight gain with lithium) and consistent denial of treatment efficacy. The two years prior to quetiapine treatment were characterised by the worsening of her illness (6 hospitalisations, 198 days). During a manic episode 26 months ago, characterised by elevated mood, irritability, paranoid delusions and aggressive behaviour (mania with psychotic symptoms), quetiapine was introduced for the first time and titrated up to 600 mg twice daily, over two weeks, in association with lorazepam 15 mg/day. No other mood stabilising agent was prescribed, due to patient refusal. Ms A responded well within 8 weeks [Bech-Rafaelsen Mania Scale (MAS) at entry 36, MAS at discharge 5]. She did not have any subsequent depressive episodes and reported a complete remission of the psychotic symptoms.

She tolerated quetiapine better than her previous medication. Lorazepam was tapered over the last 2 weeks. Due to persistent sedation, quetiapine dosage was lowered to 800 mg daily.

During the following two years, Ms A remained on the same treatment. The severity as well as the number of episodes decreased (2 episodes with psychotic symptoms: 1 manic, 1 depressive over the 2 years) leading to only 1 hospitalisation (21 days) during the observed period.

Ms A required, during the reported mood episodes, a temporary increase in quetiapine dosage up to 1400 mg daily, in association with lorazepam up to 10 mg per day. Furthermore, 2 brief hypomanic periods were controlled by an increase of quetiapine dosage, up to 1000 mg daily. In parallel to the reported mood stabilisation, Ms A experienced, for the first time in her adult life, affective stability over the two year period. In addition, her accommodation remained stable during this period. She consulted regularly at our outpatient clinic and received individual psychoeducation sessions aiming at relapse prevention. Quetiapine blood concentration was 110 ng/ml at a dosage of 800 mg/day, indicating good compliance and a quetiapine metabolism in the usual range.[5] Electrocardiogram, serum electrolytes, thyroid hormones, transaminases and blood count were normal.


  Discussion Top


The present case report describes an important and sustained improvement in mood and psychotic symptoms in a patient with SAD, treated by quetiapine alone, in dosages between 800 to 1400 mg/ day. The improvement observed during the manic and depressive episodes concord with previous studies.[2],[3] Furthermore, quetiapine seems to be well tolerated in dosages higher than 800 mg, as suggested by previous reports.[6] The reduction in the number and severity of episodes, during the two year observation, leads to the consideration of the potential long-term mood stabilising properties of quetiapine. This observation concords with previous studies on the mood stabilising effect of olanzapine, another atypical antipsychotic.[7]

We cannot exclude that the observed improvement is the result of natural evolution or of impact of other factors such as psychosocial/personal issues, psychoeducation or interactions of those factors with quetiapine compliance.


  Conclusion Top


This case suggests that quetiapine has a long-term mood stabilising effect. Double-blind, long-term controlled studies with quetiapine are needed to determine the effectiveness of this agent in the maintenance treatment of bipolar and schizoaffective bipolar disorders.

 
  References Top

1.Yatham LN, Goldstein JM, Vieta E, Bowden CL, Grunze H, Post RM, et al . Atypical antipsychotics in bipolar depression: Potential mechanisms of action. J Clin Psychiatry 2005;66:40-8.  Back to cited text no. 1    
2.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, randomised, placebo-controlled studies. Curr Med Res Opin 2005;21:923-34.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Calabrese JR, Keck PE Jr., Macfadden W, Minkwitz M, Ketter TA, Weisler RH, 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: 1341-60.  Back to cited text no. 3    
4.Ghaemi SN, Katzow JJ. The use of quetiapine for treatment-resistant bipolar disorder: A case series. Ann Clin Psychiatry 1999;11:137-40  Back to cited text no. 4  [PUBMED]  
5.Small JG, Hirsch SR, Arvanitis LA, Miller BG, Link CG. Quetiapine in patients with schizophrenia. A high- and low-dose double-blind comparison with placebo. Seroquel study group. Arch Gen psychiatry 1997;54: 549-7.  Back to cited text no. 5  [PUBMED]  
6.Pierre JM, Wirshing DA, Wirshing WC, Rivard JM, Marks R, Mendenhall J, et al . High-dose quetiapine in treatment refractory schizophrenia. Schizophr Res 2005;73:373-5.  Back to cited text no. 6    
7.Tohen M, Chengappa KN, Suppes T, Baker RW, Zarate CA, Bowden CL, et al . Relapse prevention in bipolar I disorder: 18 months comparison of olanzapine plus mood stabiliser v. mood stabiliser alone. Br J Psychiatry 2004;184:337-45.  Back to cited text no. 7    




 

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