Quetiapine in Bipolar Disorder: A Decade of Evidence

May 4, 2015
Jeannette Y. Wick, RPh, MBA, FASCP

The search for better treatment approaches has led clinicians to use atypical antipsychotics to augment or replace conventional approaches.

Bipolar disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition as a spectrum disorder with a wide variety of linked conditions, symptoms, and traits. This can be frustrating for bipolar patients, as they are often diagnosed incorrectly or too late due to their comorbidities.

For those formally diagnosed, clinicians must often adjust medications and use polymedicine to adequately address all recurrent issues. The search for better treatment approaches has led clinicians to use atypical antipsychotics to augment or replace conventional approaches.

Clinical Psychopharmacology and Neuroscience recently published a review describing the use of quetiapine (Seroquel) in patients with bipolar disorder. Although the second-generation antipsychotic was initially approved for schizophrenia, controlled studies demonstrate the drug’s efficacy in maintenance treatment of bipolar disorder.

Currently, the FDA approves the use of quetiapine for acute treatment of manic episodes associated with bipolar I disorder as monotherapy, and as an adjunct to lithium or divalproex. It is also approved for maintenance treatment of bipolar I disorder as an adjunct to lithium or divalproex, as well as acute treatment of depressive episodes.

Conventional antipsychotics are effective antimanic agents, but their long-term use tends to induce secondary depressive symptoms in bipolar patients. By comparison, several studies suggest the second-generation atypical antipsychotic can manage acute mania and other phases of bipolar disorder. The critical difference is the atypical antipsychotics’ affinity for different 5HT serotonin receptors.

This review is of interest to clinicians because it involves studies published in the last decade, including those that were clinically sound and demonstrated efficacy for specific problems, such as agitation and recurrence prevention.

Quetiapine’s side effect profile and propensity to be well tolerated offers advantages over traditional medications, and it also requires no therapeutic blood monitoring.

Acknowledging the drug’s association with metabolic side effects, the review author advises clinicians to watch carefully for obesity, dyslipidemia, and hyperglycemia, as well as warn patients about the same.