Quetiapine in the treatment of rapid cycling bipolar disorder

Introduction: This prospective open-label study assessed the impact of add-on quetiapine in the treatment of rapid cycling bipolar patients. Methods: Fourteen rapid cycling bipolar patients were treated with quetiapine, which was added to their ongoing medication regimen for 112+/-33 days. At the beginning of the study, five were manic, three were in a mixed state, three were depressed, two hypomanic and one was euthymic. Patients were assessed prospectively with a modified version of the Clinical Global Impression Scale for Bipolars (CGI-BP), the Young Scale for mania (YMRS) and the Hamilton Scale for Depression (HDRS). Results: A significant reduction of the following scale scores was observed: a 1.8 point reduction. for the general CGI-BP (p=0.013), a-1.3 point for the mania subscale (p=0.016), a -1.01 point for the YMRS (p=0.025). Improvement in depressive symptoms was not significant, neither in the CGI-BP (-1 point, p=0.074) nor in the HDRS (-5.2 points, p=NS). The most common side-effect was sedation (n=6, 43%). Doses of quetiapine were significantly reduced by the end of the study (443+/-235 mg/day versus 268+/-190 mg/day, p=0.008) and they also differed according to the initial episode to be treated (720+/-84 mg/day for mania and 183+/-29 mg/day for depression, p=0.023). Conclusions: Quetiapine could possibly be an effective treatment for rapid cycling bipolar patients. Adequate doses for acute episodes could significantly differ according to the episode polarity and the length of treatment.