Pharmacotherapy of Bipolar Disorder with Quetiapine: A Recent Literature Review and an Update

Abstract

Bipolar disorder is a chronic, recurrent condition with the usual onset during adolescence or early adulthood. In the Diagnostic and Statistical Manual of Mental Disorders 5th edition, it is conceptualized as a spectrum disorder usually associated with such comorbidities as anxiety disorders and substance use disorders. It is a relatively prevalent condition often complicated by mixed episodes, rapid cycling, subsyndromal symptoms, and treatment refractoriness. In spite of carrying substantial morbidity and mortality, effective treatments are few and far between and conventional mood stabilizers are often unsuccessful in controlling the various manifestations of the disorder. In this scenario, second generation antipsychotics are emerging as treatments with valid efficacy in all phases of bipolar disorder. Quetiapine is a versatile atypical antipsychotic which was first approved for the treatment of schizophrenia, but latter on the basis of controlled studies earned United States Food and Drug Administration's approval for acute as well as maintenance treatment of this difficult to treat condition. In this review, recently published studies in the last 10 years were examined to update the knowledge about the efficacy and safety of quetiapine in the treatment of bipolar disorder. The medication's clinical pharmacology was first considered followed by a literature review summarizing its uses in bipolar disorder. The conclusion was that quetiapine was efficacious in manic, mixed and depressive episodes and as a maintenance agent with a good tolerability profile.

Efficacy of Low Adjunctive Quetiapine Administration in Control of Hypomanic State in Bipolar Affective Disorder Captured by EEG

“…Adjunctive administrations of drug agents such as antipsychotics of second generation (SGA) targeting dopamine receptors such as Risperidone, Olanzapine or Quetiapine, are accepted for handling or even preventing switches of bipolar disorders to manic or depressive moods [1]. Indeed, quetiapine has been approved by the United States Food and Drug Administration (FDA) as for treatment of all phases of bipolar disorder, i.e.…”

“…Indeed, quetiapine has been approved by the United States Food and Drug Administration (FDA) as for treatment of all phases of bipolar disorder, i.e. manic, mixed and depressive exacerbations and maintenance either as monotherapy or as an adjunct to other mood stabilizers [1]. Quetiapine is increasingly prescribed to bipolar disorders along all courses of this disorder, indicating a convincing option in psychopharmaceutical treatment of bipolar disorder, but also emphasizing a particular attention in clinical routine [14].…”

“…Due to its pharmacological properties as approved in clinically positive responses to psychotic, mood and anxiety disorders, quetiapine and its metabolic norquetiapine is considered as a multifunctional psychoactive drug due its broad efficacy by modifying dopaminergic, serotonergic and noradrenergic neurotransmission [19]. In fact, quetiapine acts by blocking D1 and D2 receptors as reasonable for modifying psychotic states, whereby the metabolic norquetiapine with its antagonising actions of the 5HT2A and 5HT2C receptor seems to be predominately responsible for mood regulation by facilitating dopamine release at prefrontal cortex sites [1]. Moreover, quetiapine and norquetiapine show a high affinity also to 5HT1A with its property of increasing, among others, the serotonine neurotransmission of the raphe neurons as known as a crucial area of vigilance regulation [20].…”

“…Notwithstanding the current recommendations, quetiapine in bipolar mania should be established by a usual dosage of quetipaine 400-800 mg per day [24], which also covers the typically focused dose ranges of clinical research as obtained by reviewed study data of original and meta-analysis research to quetiapine in bipolar disorder in a very recent overview of Muneer [1].…”

Morbidity in Depressive Disorders

“…Among anticonvulsants (carbamazepine, divalproex, and lamotrigine), evidence for benefits in acute bipolar depression is weak [72], although lamotrigine has some protective effect against depressive recurrences [5,73]. Benefits in bipolar depression have also emerged with some atypical antipsychotics originally developed to treat schizophrenia and mania, including olanzapine combined with fluoxetine, quetiapine, lurasidone, and perhaps cariprazine [5,74,75,76,77]. Such treatments offer the additional benefit of lacking the risk of inducing (hypo)mania (some can induce akathisia or agitation), with little effect or possible benefits for suicidal behaviors [78,79].…”