Quetiapine in bipolar disorder and cocaine dependence.
OBJECTIVE
Bipolar disorder is associated with the highest rates of substance abuse of any psychiatric illness. Therefore, treatments that stabilize mood and decrease drug use or cravings are of great interest. Atypical antipsychotics are in widespread use in patients with bipolar disorder. However, minimal data are available on their use in bipolar patients with comorbid substance abuse.


METHODS
Open-label, add-on, quetiapine therapy was examined for 12 weeks in 17 outpatients with bipolar disorder and cocaine dependence. Subjects were evaluated with a structured clinical interview; Hamilton Depression Rating (HDRS), Young Mania Rating (YMRS), Brief Psychiatric Rating (BPRS) scales; and Cocaine Craving Questionnaire (CCQ). Urine samples and self-reported drug use were also obtained. Data were analyzed using a last observation carried forward method on all subjects given medication at baseline.


RESULTS
Significant improvement from baseline to exit was observed in HDRS, YMRS, BPRS and CCQ scores (p < or = 0.05). Dollars spent on cocaine and days/week of cocaine use decreased non-significantly, and urine drug screens did not change significantly from baseline to exit. Quetiapine was well tolerated, with no subjects to our knowledge discontinuing because of side-effects.


CONCLUSIONS
The use of quetiapine was associated with substantial improvement in psychiatric symptoms and cocaine cravings. The findings are promising and suggest larger controlled trials of quetiapine are needed in this population.
Brown
E Sherwood
ES
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas 75390, USA. sherwood.brown@utsouthwestern.edu
Nejtek
Vicki A
VA
Perantie
Dana C
DC
Bobadilla
Leonardo
L
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D019970:Cocaine-Related Disorders / Q000150:complications / Q000188:drug therapy* / Q000652:urine; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D003987:Dibenzothiazepines / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010555:Personality Inventory / Q000706:statistics & numerical data; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D000069348:Quetiapine Fumarate; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate