Adjunctive quetiapine for treatment-resistant adolescent major depressive disorder: a case series.
BACKGROUND
Major depressive disorder (MDD) is a leading cause of disability and mortality in adolescents. Empirical evidence suggests that many adolescents with MDD do not respond or respond only partially to commonly used interventions (antidepressants, psychotherapy, or a combination of antidepressants and psychotherapy). There is preliminary data in adults that adjunctive second-generation antipsychotics may be useful in treatment-resistant depression.


OBJECTIVE
The aim of this study was to obtain preliminary data regarding the safety, tolerability, and clinical usefulness of quetiapine as adjunctive therapy for adolescents (13-18 years of age) diagnosed with treatment-resistant MDD. Treatment-resistant MDD was defined as a failure to respond to an adequate dose for at least 8 weeks of a selective serotonin reuptake inhibitor (SSRI).


METHODS
The medical charts of 10 adolescents (13-18 years of age) diagnosed with treatment- resistant MDD, who were treated with adjunctive quetiapine, were evaluated. Doses of preexisting antidepressants remained unchanged during the period of evaluation. Response to treatment was defined as a Clinical Global Impression-Improvement (CGI-I) score of 1 (very much improved) or 2 (much improved).


RESULTS
Seven adolescents (70%) qualified as responders to treatment with adjunctive quetiapine. The median dose of quetiapine was 200 mg (mean +/- SD = 275 +/- 190.4 mg, range; 150-800 mg). Side effects included sedation (40%) and weight gain (mean +/- SD = 4.5 +/- 7.24 pounds). There was no serious adverse event.


CONCLUSIONS
This case series suggests that there may be a role for adjunctive quetiapine in treatment-resistant adolescent depression. Clinical safety and efficacy trials of quetiapine in this population appear to be warranted.
Pathak
Sanjeev
S
Children's Hospital Medical Center, Division of Child and Adolescent Psychiatry, Cincinnati, Ohio 45229, USA. sanjeev.pathak@cchmc.org
Johns
Erin S
ES
Kowatch
Robert A
RA
D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D000069348:Quetiapine Fumarate; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D015430:Weight Gain / Q000187:drug effects
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate; D017367:Selective Serotonin Reuptake Inhibitors