Efficacy of Quetiapine Monotherapy in Rapid-Cycling Bipolar Disorder in Comparison With Sodium Valproate

Langosch, Jens M.; Drieling, Tobias; Biedermann, N. C.; Born, Christoph; Sasse, Johanna; Bauer, Hartmut; Walden, J.; Bauer, Michael; Grunze, Heinz

doi:10.1097/jcp.0b013e318185e75f

Cited by 28 publications

(14 citation statements)

References 24 publications

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“…Weight-gaining effect of lithium and valproate appear similar to olanzapine and quetiapine but some recent studies 61,62 suggest that it may be lower than these 2 SGAPs and comparable to that of risperidone. Patients taking olanzapine or quetiapine for maintenance of bipolar disorder may be candidates to be switched to either lithium or valproate.…”

Section: Weight Effect Of Mstsmentioning

confidence: 94%

Weight Considerations in Psychotropic Drug Prescribing and Switching

Hasnain

Vieweg

2013

Postgraduate Medicine

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Our review describes potential weight-altering effects of psychotropic medications (antipsychotics, antidepressants, anti-anxiety medications, mood stabilizers, sedative-hypnotics, medications for attention-deficit/hyperactivity disorder, and other psychotropic medications) and offers guidance on switching a medication if its weight-altering effect becomes problematic. For second-generation antipsychotics, the risk of weight gain is high with clozapine and olanzapine, low with amisulpride, aripiprazole, and ziprasidone, and medium with other second-generation antipsychotics. Switching from a high-risk antipsychotic to a low-risk antipsychotic usually mitigates or reverses weight gain. For second-generation antidepressants, there may be modest weight loss with bupropion and modest weight gain with mirtazapine and paroxetine. Other second-generation antidepressants are weight neutral but individual variations can occur. If significant change in weight occurs, switching to or adding a low-risk second-generation antidepressant should be considered. Mood stabilizers include lithium, valproate, carbamazepine, lamotrigine, oxcarbazepine, and most second-generation antipsychotics. Risk of weight gain is high with lithium and valproate and low with carbamazepine, lamotrigine, and oxcarbazepine. Given the complexity of bipolar disorder and its management, a switch of a mood stabilizer would be best done by a psychiatrist. Benzodiazepines, non-benzodiazepine and melatonergic hypnotics, doxepin, and trazodone are weight neutral. Diphenhydramine may cause weight-gain and can be switched to a weight-neutral hypnotic if needed. Stimulants can cause varying degrees of weight loss and switching to atomoxetine or bupropion may reverse this problem. If that fails, switching to clonidine or guanfacine can be tried. Switching must be evidence-based and take into account status of the condition being treated, efficacy, side effect profile, potential drug-drug interactions, required laboratory monitoring and cost of the drug(s) being considered, and patient's pregnancy status or plan. Non-pharmacological interventions both for mental disorders and overweight/obesity must be fully availed.

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Section: Weight Effect Of Mstsmentioning

confidence: 94%

Weight Considerations in Psychotropic Drug Prescribing and Switching

Hasnain

Vieweg

2013

Postgraduate Medicine

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“…Valproate was significantly better tolerated in terms of lower rates of tremor and polyuria/polydipsia although the discontinuation rate for adverse events did not differ between the two groups. The second RCT compared valproate and quetiapine monotherapy over 12 months [47]. Patients experienced less depressive days with quetiapine than valproate but the two treatments did not differ in the number of days with manic or hypomanic symptoms.…”

Section: Valproate Monotherapy In Maintenance Treatmentmentioning

confidence: 99%

“…Two RCTs have assessed valproate in the maintenance treatment of rapid cycling patients [46,47]. In one RCT, patients who had responded to combined treatment with lithium and valproate were randomized to a 20-month maintenance phase of lithium or valproate monotherapy [46].…”

Section: Valproate Monotherapy In Maintenance Treatmentmentioning

confidence: 99%

A review of valproate in psychiatric practice

Haddad

Das

Ashfaq

et al. 2009

Expert Opinion on Drug Metabolism & Toxicology

122

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Valproate (2-propylpentanoate) is available as valproic acid, sodium valproate and semisodium valproate. It has actions on dopamine, GABA and glutamate neurotransmission and intracellular signaling. Its main psychiatric use is to treat bipolar disorder. It has been used in other psychiatric disorders, including schizophrenia and borderline personality disorder, but data are insufficient to recommend this. In acute mania, valproate monotherapy has similar efficacy to antipsychotic drugs and lithium whereas the combination of valproate and an antipsychotic is more effective than either drug alone. In maintenance treatment of bipolar disorder, valproate monotherapy has comparable efficacy to olanzapine although placebo-controlled evidence is limited. Maintenance treatment with valproate and quetiapine or olanzapine is more efficacious than valproate alone when an acute episode responds to the combination. Common adverse effects of valproate include weight gain, gastrointestinal symptoms, sedation, tremor and mild elevation of hepatic enzymes. Serious hepatic toxicity is rare in adults. Many adverse effects are dose related and resolve with dose reduction. Valproate is teratogenic and specifically associated with neural tube defect. Preliminary evidence has linked in utero exposure to decreased verbal intelligence in the offspring. These effects, plus a probable increased risk of polycystic ovary syndrome, limit valproate's use in women of childbearing potential.

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“…An RCT suggested that quetiapine was effective for rapid cyclers compared to valproic acid. 78 In post-hoc analyses of clinical studies on quetiapine in mainte-nance therapy, the quetiapine group of rapid cycling patients with bipolar I disorder showed a significantly longer period to recurrence than the placebo group. 39 Because tricyclic antidepressants are known to induce rapid cycling, it is necessary to discontinue these drugs.…”

Section: Rapid Cyclersmentioning

confidence: 99%

Guideline for treatment of bipolar disorder by the Japanese Society of Mood Disorders, 2012

Kanba

Kato

Terao

et al. 2013

Psychiatry Clin Neurosci

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The Japanese Society of Mood Disorders established a committee for treatment guidelines of mood disorders, which created the first edition of a treatment guideline for bipolar disorders on 10 March 2011. The committee has now created a second edition, which we report here. In creating this treatment guideline, the first step was to have several bipolar disorder specialists review well-conducted studies and meta-analyses. Based on this evidence, and with a consensus among the specialists, treatment procedures that were considered optimal were compiled and the strength of recommendation for each treatment method was determined. The first draft, prepared in this manner, was further revised through a process of critical investigation by all committee members to produce the final edition.

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Efficacy of Quetiapine Monotherapy in Rapid-Cycling Bipolar Disorder in Comparison With Sodium Valproate

Abstract: In this study, quetiapine was more effective than VPA on the number of depressive days and similar to VPA in the treatment of manic symptoms. Quetiapine was associated with a greater incidence of side effects, particularly orthostatic dysregulation, sedation, and weight gain.

Cited by 28 publications

References 24 publications

Weight Considerations in Psychotropic Drug Prescribing and Switching

Weight Considerations in Psychotropic Drug Prescribing and Switching

A review of valproate in psychiatric practice

Guideline for treatment of bipolar disorder by the Japanese Society of Mood Disorders, 2012

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