Quetiapine for acute mania in bipolar disorder.
OBJECTIVE
The efficacy and tolerability of quetiapine in the treatment of acute mania were reviewed.


CONCLUSIONS
Five randomized, placebo-controlled trials involving quetiapine as monotherapy or adjunct therapy in combination with either divalproex or lithium in the treatment of bipolar mania in either adolescents or adults were identified and reviewed. The primary outcome measure used in the trials was a change in Young Mania Rating Scale total scores. Monotherapy trials evaluated quetiapine, lithium, haloperidol, and placebo. Quetiapine was superior to placebo in both trials. Quetiapine and lithium showed comparable efficacy in one study, though lithium serum concentrations may have been suboptimal. Haloperidol was superior to quetiapine in efficacy at day 21 but similar at day 84. In the two trials evaluating quetiapine or placebo as adjunct therapy to lithium or divalproex, quetiapine was significantly more efficacious than placebo in one trial. In adolescents, quetiapine was more effective than placebo as an adjunct to divalproex. The most common adverse effects clearly attributable to quetiapine in these trials were somnolence and dry mouth. Quetiapine did not induce extrapyramidal effects, but weight gain was notable with the drug.


CONCLUSIONS
While quetiapine treatment demonstrated efficacy in the majority of the studies, the robustness of its efficacy is questionable. The use of quetiapine as first-line therapy for acute mania is not recommended based on the available results and cost considerations. However, it may be a useful second-line agent, particularly when sensitivity to extrapyramidal symptoms limits treatment options.
Brahm
Nancy C
NC
Department of Pharmacy Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy (UOCP), Tulsa, OK 74135-2512, USA. nancy-brahm@ouhsc.edu
Gutierres
Sheryl L
SL
Carnahan
Ryan M
RM
D000208:Acute Disease; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D014635:Valproic Acid / Q000627:therapeutic use
D018692:Antimanic Agents; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D018020:Lithium Compounds; D000069348:Quetiapine Fumarate; D014635:Valproic Acid; D006220:Haloperidol