title: Quetiapine as combination treatment with citalopram in unipolar depression with prominent somatic symptoms: a randomised, double-blind, placebo-controlled pilot study.
abstract: BACKGROUND
  Patients with major depressive disorder (MDD) accompanied by physical symptoms may be less responsive to antidepressant treatment. Quetiapine has been evaluated in the treatment of bipolar depression and has been recently approved as an add-on therapy for unipolar depression. Less is known about the efficacy of combination therapies in patients suffering from MDD with somatic symptoms. The aim of the present study was to evaluate the efficacy of quetiapine as adjunctive therapy to the SSRI citalopram in patients with MDD and somatic complaints.
  
  
  METHODS
  41 inpatients with nonpsychotic DSM-IV MDD experiencing significant symptoms of somatic distress as defined by a baseline score on the SCL-90-R somatization subscale greater one standard deviation above adult nonpatient norms were randomly assigned to receive either citalopram 40 mg/day plus placebo (n=20) or citalopram 40 mg/day plus quetiapine, 300 to 600 mg/day (n=21) for 6 weeks. The primary outcome measure was the Hamilton Depression Rating Scale (HDRS) score.
  
  
  RESULTS
  Mean changes in HDRS scores from baseline to week 6 using last-observation-carried-forward methods were -12.3±6.2 and -10.7±5.1 in the citalopram-quetiapine and citalopram-placebo group, respectively. Remission rates were significant higher in the citalopram-quetiapine-group (41.1%) than in the citalopram-placebo-group (26.3%), respectively.
  
  
  CONCLUSIONS
  Although quetiapine as add-on to citalopram did not separate statistically from placebo on the HDRS score in improving depressive symptoms and somatic symptoms in patients with MDD and prominent somatic complaints, higher remission rates and other second outcome parameters showed advantages for quetiapine. Larger, double-blind, placebo-controlled trials of quetiapine as augmentation therapy in MDD with somatic symptoms are warranted.
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Eschenallee 3, 14050 Berlin, Germany, arnim.quante@charite.de.
authors.forename: Arnim
authors.initials: A
authors.lastname: Quante
authors.forename: Francesca
authors.initials: F
authors.lastname: Regen
authors.forename: Frank
authors.initials: F
authors.lastname: Schindler
authors.forename: Klaus
authors.initials: K
authors.lastname: Volkmer
authors.forename: Emanuel
authors.initials: E
authors.lastname: Severus
authors.forename: Carsten
authors.initials: C
authors.lastname: Urbanek
authors.forename: Alexander
authors.initials: A
authors.lastname: Luborzewski
authors.forename: Stefan
authors.initials: S
authors.lastname: Roepke
authors.forename: Ion
authors.initials: I
authors.lastname: Anghelescu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D017024:Chemotherapy, Adjuvant; D015283:Citalopram / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D003987:Dibenzothiazepines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010919:Placebos; D011602:Psychophysiologic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D000069348:Quetiapine Fumarate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010919:Placebos; D015283:Citalopram; D000069348:Quetiapine Fumarate