A double-blind, placebo-controlled pilot study of quetiapine for depressed adolescents with bipolar disorder.
OBJECTIVE
To conduct a pilot study comparing the effects of quetiapine and placebo for the treatment of depressive episodes in adolescents with bipolar I disorder.


METHODS
Thirty-two adolescents (ages 12-18 years) with a depressive episode associated with bipolar I disorder were randomized to eight weeks of double-blind treatment with quetiapine, 300-600 mg/day, or placebo. This two-site study was conducted from March 2006 through August 2007. The primary efficacy measure was change in Children's Depression Rating Scale-Revised Version (CDRS-R) scores from baseline to endpoint. Secondary efficacy measures included change in CDRS-R scores over the eight-week study period (PROC MIXED), changes from baseline to endpoint in Hamilton Anxiety Rating Scale (HAM-A), Young Mania Rating Scale (YMRS), and Clinical Global Impression-Bipolar Version Severity (CGI-BP-S) scores, as well as response and remission rates. Safety and tolerability were assessed weekly.


RESULTS
There was no statistically significant treatment group difference in change in CDRS-R scores from baseline to endpoint (p = 0.89, effect size =-0.05, 95% confidence interval: -0.77-0.68), nor in the average rate of change over the eight weeks of the study (p = 0.95). Additionally, there were no statistically significant differences in response (placebo =67% versus quetiapine = 71%) or remission (placebo = 40% versus quetiapine = 35%) rates, or change in HAM-A, YMRS, or CGI-BP-S scores (all p > 0.7) between treatment groups. Dizziness was more commonly reported in the quetiapine (41%) than in the placebo (7%) group (Fisher's exact test, p = 0.04).


CONCLUSIONS
The results suggest that quetiapine monotherapy is no more effective than placebo for the treatment of depression in adolescents with bipolar disorder. However, limitations of the study, including the high placebo response rate, may have contributed to our findings and should be considered in the design of future investigations of pharmacological interventions for this population.
DelBello
Melissa P
MP
Division of Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, ML 559, Cincinnati, OH 45219, USA. delbelmp@email.uc.edu
Chang
Kiki
K
Welge
Jeffrey A
JA
Adler
Caleb M
CM
Rana
Manasi
M
Howe
Meghan
M
Bryan
Holly
H
Vogel
Daniel
D
Sampang
Suzanne
S
Delgado
Sergio V
SV
Sorter
Michael
M
Strakowski
Stephen M
SM
D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D001835:Body Weight / Q000187:drug effects; D002648:Child; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D003987:Dibenzothiazepines / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D055442:Metabolome / Q000187:drug effects; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D000069348:Quetiapine Fumarate; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate