Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2009

Open Access 01-12-2009 | Research article

Maintenance treatment of adolescent bipolar disorder: open study of the effectiveness and tolerability of quetiapine

Authors: Anne Duffy, Robert Milin, Paul Grof

Published in: BMC Psychiatry | Issue 1/2009

Login to get access

Abstract

Background

The purpose of the study was to determine the effectiveness and tolerability of quetiapine as a maintenance treatment preventing against relapse or recurrence of acute mood episodes in adolescent patients diagnosed with bipolar disorder.

Methods

Consenting patients meeting DSM-IV lifetime criteria for a bipolar disorder and clinically appropriate for maintenance treatment were enrolled in a 48-week open prospective study. After being acutely stabilized (CGI-S ≤ 3 for 4 consecutive weeks), patients were started or continued on quetiapine and other medications were weaned off over an 8-week period. Quetiapine monotherapy was continued for 40-weeks and other mood stabilizers or antidepressants were added if clinically indicated. A neurocognitive test battery assessing the most reliable findings in adult patients was administered at fixed time points throughout the study to patients and matched controls.

Results

Of the 21 enrolled patients, 18 completed the 48-week study. Thirteen patients were able to be maintained without relapse or recurrence in good quality remission on quetiapine monotherapy, while 5 patients required additional medication to treat impairing residual depressive and/or anxiety symptoms. According to symptom ratings and global functioning scores, the quality of remission for all patients was very good.
Neurocognitive test performance over treatment was equivalent to that of a matched control group of never ill adolescents. Quetiapine was generally well tolerated with no serious adverse effects.

Conclusion

This study suggests that a proportion of adolescent patients diagnosed with bipolar disorder can be successfully maintained on quetiapine monotherapy. The good quality of clinical remission and preserved neurocognitive functioning underscores the importance of early diagnosis and effective stabilization.

Clinical Trials Registry

D1441L00024
Appendix
Available only for authorised users
Literature
1.
Leboyer M, Henry C, Paillere-Martinot M, Bellivier F: Age at onset in bipolar affective disorders: a review. Bipolar Disord. 2005, 7: 111-118. 10.1111/j.1399-5618.2005.00181.x.CrossRefPubMed
2.
Kafantaris V, Coletti DJ, Dicker R, Padula G, Kane JM: Lithium treatment of acute mania in adolescents: a large open trial. J Am Acad Child Adolesc Psychiatry. 2003, 1038-1045. 10.1097/01.CHI.0000070247.24125.24.
3.
Kafantaris V, Coletti DJ, Dicker R, Padula G, et al: Lithium treatment of acute mania in adolescents: a placebo-controlled discontinuation study. J Am Acad Child Adolesc Psychiatry. 2004, 43: 984-883. 10.1097/01.chi.0000129223.89433.74.CrossRefPubMed
4.
Geller B, Cooper TB, Sun K, Zimerman B, Frazier J, Williams M, et al: Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependence. J Am Acad Child Adolesc Psychiatry. 1998, 37 (2): 171-178. 10.1097/00004583-199802000-00009.CrossRefPubMed
5.
DelBello MP, Hanseman D, Adler CM, Stanford KE, Welge JA, Barzman DH, et al: A double-blind randomized pilot study comparing quetiapine and divalproex for adolescent mania. J Am Acad Child Adolesc Psychiatry. 2006, 45: 305-313.CrossRefPubMed
6.
DelBello MP, Schwiers ML, Rosenberg L, Strakowski SM: A double-blind, randomized, placebo-controlled study of quetiapine as adjunctive treatment for adolescent mania. J Am Acad Child Adolesc Psychiatry. 2002, 41: 1216-1223. 10.1097/00004583-200210000-00011.CrossRefPubMed
7.
Wagner K, Kowatch R, Emslie G, Findling RL, Wilens TE, McCague K, et al: A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents. The American Journal of Psychiatry. 2006, 163: 1179-1186. 10.1176/appi.ajp.163.7.1179.CrossRefPubMed
8.
Kowatch RA, Fristad MA, Birmaher B, Wagner K, Findling RL, Hellander M, et al: Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2005, 44: 213-235. 10.1097/00004583-200503000-00006.CrossRefPubMed
9.
Kowatch RA, Suppes T, Carmody TJ, Bucci JP, Hume JH, Kromelis M, et al: Effect size of lithium, divalproex sodium, and carbamazepine in children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2000, 39: 713-720. 10.1097/00004583-200006000-00009.CrossRefPubMed
10.
Duffy A: Lithium treatment in children and adolescents: A selected review and integration of research findings. Lithium in Neuropsychiatry: The Comprehensive Guide. Edited by: Bauer M, Grof P, Muller-Oerlinghausen B. 2006, London, UK: Taylor & Francis Book Ltd, 193-206.CrossRef
11.
Garland JE, Duffy A: Treating bipolar disorder in the early stages of the illness. Practical Management of Bipolar Disorder: A Guide for Clinicians. 2009
12.
Phillips L, Yung A, Yuen H, Pantelis C, McGorry P: Prediction and prevention of transition to psychosis in young people at incipient risk for schizophrenia. Am J Med Genet. 2002, 114: 929-937. 10.1002/ajmg.b.10790.CrossRefPubMed
13.
Berk M, Conus P, Lucas N, Hallam KT, Malhi G, Dodds S, et al: Setting the stage: From prodrome to treatment resistance in bipolar disorder. Bipolar Disord. 2007, 9: 671-678. 10.1111/j.1399-5618.2007.00484.x.CrossRefPubMed
14.
Duffy A, Hajek T, Alda M, Grof P, Milin R, MacQueen GM: Neurocognitive functioning in the early stages of bipolar disorder: Visual backward masking performance in high risk offspring. Eur Arch Psychiatry Clin Neurosci. 2009
15.
Waddell C, McEwan K, Peters R, Hua J, Garland O: Preventing mental disorders in children: a public health priority. Can J Public Health. 2007, 98: 174-178.PubMed
16.
Judd LL, Akiskal HS: The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord. 2003, 73: 123-131. 10.1016/S0165-0327(02)00332-4.CrossRefPubMed
17.
Murray CJL, Lopez AD: The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. 1996, Boston, MA: World Health Organization
18.
MacQueen GM, Young LT, Joffe RT: A review of psychosocial outcome in patients with bipolar disorder. Acta Psychiatr Scand. 2001, 103: 163-170. 10.1034/j.1600-0447.2001.00059.x.CrossRefPubMed
19.
Ahrens B, Muller-Oerlinghausen B, Schou M, et al: Excess cardiovascular and suicide mortality of affective disorders may be reduced by lithium prophylaxis. J Affect Disord. 1995, 33: 67-75. 10.1016/0165-0327(94)00074-J.CrossRefPubMed
20.
Angst J, Stassen HH, Gross G, et al: Suicide in affective and schizoaffective disorders. Affective and Schizoaffective Disorders. Edited by: Maneros A, Tsuang MT. 1990, Berlin: Springer, 168-185.CrossRef
21.
Conus P, Berk M, McGorry P: Pharmacological treatment in the early phase of bipolar disorders: what stage are we at?. Australian and New Zealand Journal of Psychiatry. 2006, 40: 199-207. 10.1111/j.1440-1614.2006.01775.x.CrossRefPubMed
22.
Duffy A, Alda M, Milin R, Grof P: A consecutive series of treated offspring of bipolar parents: Is response associated with clinical profile?. Can J Psychiatry. 2007, 52: 369-376.PubMed
23.
Schou M: Relapse prevention in manic depressive illness: Important and unimportant factors. Can J Psychiatry. 1991, 36: 502-506.PubMed
24.
Endicott J, Paulsson B, Gustafsson U, Schioler H, Hassan M: Quetiapine monotherapy in the treatment of depressive episodes of bipolar I and II disorder: Improvements in quality of life and quality of sleep. J Affect Disord. 2008, 111: 306-319. 10.1016/j.jad.2008.06.019.CrossRefPubMed
25.
Olver JS, Ignatiadis S, Maruff P, Burrows GD, Norman TR: Quetiapine augmentation in depressed patients with partial response to antidepressants. Hum Psychopharmacol. 2008, 23: 653-660. 10.1002/hup.970.CrossRefPubMed
26.
Calabrese JR, Keck PE, Macfadden W, Minkwitz M, Ketter TA, Weisler RH, et al: A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry. 2005, 162: 1351-1360. 10.1176/appi.ajp.162.7.1351.CrossRefPubMed
27.
Thase ME, Macfadden W, Weisler RH, Chang W, Paulsson B, Khan A, et al: Efficacy of quetiapine monotherapy in bipolar I and II depression: a double-blind, placebo-controlled study (the BOLDER II study). J Clin Psychopharmacol. 2006, 26: 600-609. 10.1097/01.jcp.0000248603.76231.b7.CrossRefPubMed
28.
Duffy A, Alda M, Crawford L, Milin R, Grof P: The early manifestations of bipolar disorder: a longitudinal prospective study of the offspring of bipolar parents. Bipolar Disord. 2007, 9: 828-838.CrossRefPubMed
29.
MacQueen GM, Young LT, Galway TM, Joffe RT: Backward masking task performance in stable, euthymic out-patients with bipolar disorder. Psychol Med. 2001, 31: 1269-1277. 10.1017/S0033291701004597.CrossRefPubMed
30.
MacQueen G, Grof P, Alda M, Marriott M, Young LT, Duffy A: A pilot study of visual backward masking performance among affected versus unaffected offspring of parents with bipolar disorder. Bipolar Disord. 2004, 6: 374-378. 10.1111/j.1399-5618.2004.00133.x.CrossRefPubMed
31.
MacQueen GM, Campbell C, McEwen B, MacDonald K, Amano S, Joffe RT, et al: Course of illness, hippocampal function and hippocampal volume in major depression. Proc Natl Acad Sci USA. 2003, 100: 1387-1392. 10.1073/pnas.0337481100.CrossRefPubMedPubMedCentral
32.
Milner B, Squire L, Kandel ER: Cognitive neuroscience and the study of memory. Neuron. 1998, 20: 445-468. 10.1016/S0896-6273(00)80987-3.CrossRefPubMed
33.
Grof P: Selecting effective long-term treatment for bipolar patients: Monotherapy and combinations. J Clin Psychiatry. 2003, 64 (Suppl 5): 53-61.PubMed
34.
Grof P, Alda M, Grof E, Zvolsky P, Walsh M: Lithium response and genetics of affective disorders. J Affect Disord. 1994, 32: 85-95. 10.1016/0165-0327(94)90066-3.CrossRefPubMed
35.
Nair P, Lippmann S: Is leukopenia associated with divalproex and/or quetiapine?. Psychosomatics. 2005, 46: 188-189. 10.1176/appi.psy.46.2.188.CrossRefPubMed
36.
Oluboka O, Haslam D, Lam T, Bown-Demarco D: Quetiapine-induced leucopenia: possible dosage-related phenomenon. Can J Psychiatry. 2003, 48: 65-66.PubMed
Metadata
Title
Maintenance treatment of adolescent bipolar disorder: open study of the effectiveness and tolerability of quetiapine
Authors
Anne Duffy
Robert Milin
Paul Grof
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2009
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-9-4

Other articles of this Issue 1/2009

BMC Psychiatry 1/2009 Go to the issue

Research article

Returning home: forced conscription, reintegration, and mental health status of former abductees of the Lord's Resistance Army in northern Uganda

Research article

A new clinical rating scale for work absence and productivity: validation in patients with major depressive disorder

Study protocol

Violence and post-traumatic stress disorder in Sao Paulo and Rio de Janeiro, Brazil: the protocol for an epidemiological and genetic survey

Research article

An investigation of cognitive 'branching' processes in major depression

Research article

Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department

Research article

Psychopathic traits and offender characteristics – a nationwide consecutive sample of homicidal male adolescents