The use of atypical antipsychotics beyond psychoses: efficacy of quetiapine in bipolar disorder

Abstract

Background and rationale: Atypical antpsychotics have been sucessfully used in the treatment of bipolar disorder (BD), either as adjunctive or as monotherapy. Quetiapine is an atypical antipsychotic extensively used in the treatment of psychotic disorders. It has serotonergic and dopaminergic activity and it appears to be selective for the mesolimbic and mesocortical dopamine system. The aim of this paper was to review the recent literature on the use of quetiapine in the treatment of BD. Methods: The literature databases currently available online were searched for papers on quetiapine and BD. Papers and reports published between January 1995 and June 2005 were selected and reviewed critically. Results: Augmentative low dose quetiapine was found to be effective in BD partially responsive to conventional mood-stabilizers. Manic and mixed episodes have been the best studied, and quetiapine was found to be effective either as monotherapy or as adjunctive therapy in both randomized clinical trials and open-label studies. Data on the use of quetiapine in bipolar depression showed a significant efficacy and high remission rates. Maintenance data suggested a role of quetiapine as a good alternative to classical mood stabilizers in reducing recurrence rates of BD. A few studies on the efficacy in rapid cycling BD have also been published. Conclusions: Quetiapine is an effective agent for the short-and long-term treatment of BD.The mechanism of action of quetiapine as a mood stabilizer is still unknown. Some preliminary data suggest the involvement of glutamate pathways but further studies are needed to clarify this issue.

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

“…Both quetiapine and norquetiapine strongly antagonize this receptor, thereby easing dopamine release in the said pathways and resulting in low incidence of extrapyramidal side effects and hyperprolactinemia. 16 )…”

Bipolar Disorder in 10–17 Year Old Patients: Treatment Options and Cautions

“…However, no hypotheses exist for the mechanism of action of SGAs in preventing recurrences of BD in the longterm. 90 A recent review has analyzed the efficacy of the treatment of SGAs in BD youth with manic or mixed episodes, using the concept of the number of subjects needed to treat (NNT) and the risk for the adverse effects using the number needed to harm (NNH). 19 The NNT is the number of subjects who need to be treated with a specific treatment to yield one additional good outcome compared with placebo.…”

Quetiapine-Induced Hypomania and its Association with Quetiapine/Norquetiapine Plasma Concentrations: A Case Series of Bipolar Type 2 Patients

“…Norquetiapine, the most important active metabolite of quetiapine, has been shown to be associated with antidepressant, anxiolytic, and neurotrophic effects in humans [ 14 ]. In particular, norquetiapine facilitates dopamine release in the prefrontal cortex and inhibits dopamine reuptake [ 15 , 16 ]. Moreover, norquetiapine potentiates serotoninergic and noradrenergic transmission through its high affinity for 5-HT 1A , 5-HT 2C , and 5-HT 7 receptors and through noradrenaline reuptake inhibition [ 17 , 18 ].…”