title: Influence of single-dose quetiapine on fear network activity - A pharmaco-imaging study.
abstract: Anxiety disorders are among the most frequent psychiatric disorders. Current treatment guidelines recommend antidepressants, the calcium modulator gabapentin, and benzodiazepines as pharmacological treatments. However, delayed onset of action precludes the use of antidepressants as an acute treatment, while benzodiazepines can be recommended only as an emergency treatment due to their inherent risk of dependence. Therefore, an alternative pharmacological agent with acute efficacy is needed. Preliminary evidence points towards possible anxiolytic properties of the atypical antipsychotic quetiapine. The goals of this study were to test the acute anxiolytic properties of quetiapine in patients suffering from arachnophobia in a challenge paradigm, and to assess the effects of quetiapine on the central nervous fear network.
  
  
  
  In a randomized, double-blind, placebo-controlled proof-of-concept study, n=58 arachnophobic patients underwent an fMRI scan while looking at phobia-related and neutral stimuli. Subjective anxiety was evaluated retrospectively in questionnaires.
  
  
  
  The functional imaging data revealed that patients showed stronger amygdala activation to phobia-related than to neutral stimuli. However, no effect of quetiapine on fear network activity was detected. Further, on questionnaire measures, quetiapine significantly reduced somatic anxiety symptoms, but had no effect on general psychological anxiety.
  
  
  
  Viewing phobic pictures resulted in a robust amygdala activation in arachnophobic patients. Quetiapine seems to have no influence on activation in anxiety-related brain areas but appears to reduce acute somatic anxiety symptoms in patients with specific phobia. The central nervous correlates of the anxiolytic effects of quetiapine remain to be clarified in future studies.
authors.affiliation: Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany. Electronic address: julia.diemer@kbo.de.
authors.forename: J
authors.initials: J
authors.lastname: Diemer
authors.affiliation: Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany. Electronic address: peter.zwanzger@kbo.de.
authors.forename: P
authors.initials: P
authors.lastname: Zwanzger
authors.affiliation: Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Fohrbeck
authors.affiliation: Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany. Electronic address: maxim.zavorotnyy@med.uni-marburg.de.
authors.forename: M
authors.initials: M
authors.lastname: Zavorotnyy
authors.affiliation: Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany. Electronic address: swantje.notzon@ukmuenster.de.
authors.forename: S
authors.initials: S
authors.lastname: Notzon
authors.affiliation: Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany. Electronic address: karen.silling@ukmuenster.de.
authors.forename: K
authors.initials: K
authors.lastname: Silling
authors.affiliation: Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany. Electronic address: sekre.arolt@ukmuenster.de.
authors.forename: V
authors.initials: V
authors.lastname: Arolt
authors.affiliation: Department of Psychiatry, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149 Muenster, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080 Wuerzburg, Germany. Electronic address: Domschke_K@klinik.uni-wuerzburg.de.
authors.forename: K
authors.initials: K
authors.lastname: Domschke
authors.affiliation: Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Campus 1, Building A16, 48129 Muenster, Germany. Electronic address: pfleide@uni-muenster.de.
authors.forename: B
authors.initials: B
authors.lastname: Pfleiderer
mesh_terms: D000328:Adult; D000679:Amygdala / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology*; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000494:pharmacology*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010698:Phobic Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D000075082:Proof of Concept Study; D000069348:Quetiapine Fumarate / Q000008:administration & dosage / Q000494:pharmacology*; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D000069348:Quetiapine Fumarate
keywords: Anxiety disorder; Challenge; Quetiapine; Specific phobia; fMRI