Antipsychotics for Depression and Mania

Marcia Purse Health Guide
  • Some years ago I took part in a clinical study testing whether quetiapine (brand name Seroquel) was effective in treating bipolar depression.

     

    The results (for me) were wonderful. Taking Seroquel alone, I had a sharp decrease in depressive symptoms. That it was due to the drug became very evident when, during the second half of the study, participants were reshuffled randomly to receive either quetiapine or the placebo, just as in the first half.

     

    It became clearly obvious that in the re-randomization, I had been assigned to the placebo. My mood plummeted so badly that I left the study to start taking Seroquel as a prescription.

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    Due partly to serious weight gain, though, my dose of quetiapine has been gradually decreased over the year, and other medications added. (Now, at 50 mg, I don't know whether it has any antidepressant effect, but I do know it helps me get to sleep.)

     

    Recently there have been studies testing olanzapine (Zyprexa) specifically for bipolar I depression, and extended release quetiapine for acute bipolar mania. In both cases, the study methods were set up so that participants were taking no other medications.

     

    In both cases, the drugs were found to be effective as singlel drug treatments (monotherapy) for the respective conditions. Good news, eh? BUT in the olanzapine trial, which lasted only six weeks (mine lasted much longer), a significant number of patients taking the drug gained 7% or more of their body weight in this relatively short time, as well as having significant increases in cholesterol and triglycerides.

     

    Studying quetiapine for acute mania needed less time, only 3 weeks. Improvement was seen in the true drug group in as little as 4 days. Apparently patients weren't followed after the 3 weeks were up to see how they fared after discontinuing quetiapine, but response and remissions rates were up significantly.

     

    Could we be helped by taking fewer drugs at once? It's an enticing prospect - but not if it happens at the expense of health.

     

    References:

    Tolen, M., et al. (2012). Randomised, double-blind, placebo-controlled study of olanzapine in patients with bipolar i depression. British Journal of Psychiatry, Epub ahead of print, Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22918966

     

    Cutter, A. (2011). Extended-release quetiapine as monotherapy for the treatment of adults with acute mania: a randomized, double-blind, 3-week trial. Clinical Psychiatry, 33(11), 1643-58. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22054797

     

     

Published On: September 30, 2012