According to research presented at the American Psychiatric Association 2017 Annual Meeting, the atypical antipsychotic quetiapine may be effective in reducing substance abuse in patients with bipolar disorder and may be more effective in reducing depressive symptoms in patients with comorbid substance use disorder.1
Researchers from the mood disorders program at University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, presented results from a study investigating the effectiveness of quetiapine-extended release (quetiapine-XR) on depressive symptoms and substance use disorder (SUD) in patients with bipolar I or II depression, co-occurring or not with SUD.
A recent systematic review and meta-analysis indicated a high prevalence of SUD in both inpatients and outpatients with bipolar I and II disorder, reaching 42% for alcohol use, 20% for cannabis use, and 17% for non cannabis illicit drug use.2 In addition, this analysis and a subsequent one revealed that men with bipolar disorder are more at risk of developing SUD over the course of their lifetime than their female counterparts (P =.022).3Both analyses found diverging results regarding the effect of age and hospitalization on the prevalence of SUD in patients with bipolar disorder.2,3
In a randomized placebo-controlled study conducted over the course of 8 weeks, 91 patients with bipolar I or II depression and generalized anxiety disorder were treated with quetiapine-XR (n=22 with “recent” SUD; n=24 without SUD) or placebo (n=21 with recent SUD; n=23 without SUD). In this study, SUD included alcohol, cigarette, and marijuana use, as diagnosed according to the Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Version, and recent SUD was defined as “patients who had a diagnosis of substance dependence and continued to meet abuse or dependence criteria for substance(s) in the past six months at the initial assessment or those who had a diagnosis of substance abuse and continued abusing a substance in the last three months.”
A battery of tests (including Hamilton Depression Rating Scale-17 item, 16-item Quick Inventory of Depressive Symptomatology, and Clinical Global Impression-Severity Scale) were used to assess depression, anxiety, and severity of symptoms.
Results indicate that, among patients treated with quetiapine-XR, depressive symptoms were alleviated to a greater extent in those with co-occurring recent SUD vs those without SUD (Hamilton Depression Rating Scale-17 item: −10.8±1.7 vs −6.1±1.8 [P =.07]; Quick Inventory of Depressive Symptomatology: −9.6±1.6 vs −3.7±1.7 [P =.02]; Clinical Global Impression-Severity Scale: −1.6±0.4 vs −0.8±0.03 [P =.04]). Of note, the effect was reversed in the placebo group, in that patients without a recent SUD saw a greater reduction in their depressive symptoms than those with SUD (Hamilton Depression Rating Scale-17 item: −9.5±2.6 vs −8.1±2.6).
In addition, in patients with recent SUD, quetiapine-XR treatment led to improvements in alcohol (ie, number of drinks/week, number of heavy drinking days), marijuana (number of joints/week; P =.09), and cigarette consumption, compared with placebo.
1. Gao K, Ganocy S, Conroy C, Brownrigg B, Serrano MB, Calabrese JR. Treatment Response of Patients With Bipolar I or II Disorder With or Without a Recent Substance Use Disorder to Quetiapine or Placebo. Presented at: the American Psychiatric Association (APA) 2017 Annual Meeting; May 20-24, 2017; San Diego, CA. Abstract 38.
2. Hunt GE, Malhi GS, Cleary M, Lai HM, Sitharthan T. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990-2015: Systematic review and meta-analysis. J Affect Disord. 2016;206:331-349. doi: 10.1016/j.jad.2016.07.011
3. Messer T, Lammers G, Müller-siecheneder F, Schmidt RF, Latifi S. Substance abuse in patients with bipolar disorder: A systematic review and meta-analysis. Psychiatry Res. 2017;253:338-350. doi: 10.1016/j.psychres.2017.02.067