First study to test antipsychotic on depressive phase
Jul 4, 2005, 13:50, Reviewed by: Dr.
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"Though we will soon undertake an even larger trial, these preliminary findings should shape the standard of care for bipolar disorder going forward," says Dr. Calabrese, professor of psychiatry at Case and a nationally renowned researcher in bipolar disease. The Center, which he co-directs with pediatric psychiatrist Dr. Robert Findling, is the first NIMH-funded center exclusively dedicated to the development of new treatments for bipolar disorder.
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By University Hospitals of Cleveland,
For the first time, researchers have demonstrated in separate short-term trials that a single drug therapy may be effective in treating both the manic and depressive phases of bipolar disorder. The condition (bipolar I and II) affects approximately 8 million Americans, who have relied on a combination of drugs to manage their symptoms, and who remain at high risk of committing suicide because of the difficulty in treating the disorder.
A study of the antipsychotic drug Seroquel is published in the July issue of the American Journal of Psychiatry. The study's principal investigator is Joseph R. Calabrese, MD, principal investigator and director of the National Institute of Mental Health (NIMH) Bipolar Research Center at University Hospitals of Cleveland and Case Western Reserve University School of Medicine.
Dr. Calabrese led the randomized trial of 542 patients with bipolar depression at 39 sites in the United States. Seroquel is currently approved for the short-term treatment of acute manic episodes in bipolar I disorder and the treatment of schizophrenia. This is the first study of Seroquel in patients with both bipolar I (defined as one fully manic episode with periods of major depression) and bipolar II (defined as periods of hypomania, or high levels of energy and impulsiveness alternating with episodes of major depression), in which researchers specifically studied the drug's impact on the depressive phase of the illness. Typically, antipsychotic medications are not used as specific treatments for bipolar depression.
"Though we will soon undertake an even larger trial, these preliminary findings should shape the standard of care for bipolar disorder going forward," says Dr. Calabrese, professor of psychiatry at Case and a nationally renowned researcher in bipolar disease. The Center, which he co-directs with pediatric psychiatrist Dr. Robert Findling, is the first NIMH-funded center exclusively dedicated to the development of new treatments for bipolar disorder.
"There was a dramatic response within eight days of beginning treatment in patients who were symptomatic with bipolar depression," says Dr. Calabrese. "About 50% of patients responded quickly to treatment with Seroquel versus placebo, achieving remission from their symptoms, with the response lasting through the eighth and last week of the trial. Seroquel was also twice as effective as placebo in decreasing suicidal thoughts associated with acute bipolar depression."
"Patients who respond most positively are probably those who also exhibit anxiety and agitation," adds Dr. Calabrese. "We are not certain as to the mechanism of action in the brain, however we know the drug impacts neurotransmitters dopamine and serotonin. The most common side effect is fatigue, so it may not be the best initial approach in patients who experience significant lethargy as a symptom of depression."
The trial tested two dose levels of Seroquel (quetiapine fumarate), 300 or 600mg/d, versus placebo. Of the 539 patients enrolled, 358 had bipolar I and 181 had bipolar II. Common side effects included dry mouth (43%), sedation (31%), sleepiness (26%), dizziness (20%) and constipation (11%). The research was supported by AstraZeneca Pharmaceuticals. 
- July issue of the American Journal of Psychiatry
www.uhhs.com
This study was first presented at the 2004 annual meeting of the American Psychiatric Association.
University Hospitals Health System (UHHS) is the region's premier healthcare delivery system, serving patients at more than 150 locations throughout northern Ohio. The System's 947-bed, tertiary medical center, University Hospitals of Cleveland (UHC), is the primary affiliate of Case Western Reserve University (Case). Together, they form the largest center for biomedical research in the State of Ohio. The System provides the major clinical base for translational researchers at the Case Research Institute, a partnership between UHC and Case School of Medicine, as well as a broad and well-characterized patient population for clinical trials involving the most advanced treatments. Included in UHC are Rainbow Babies & Children's Hospital, among the nation's best children's hospitals; Ireland Cancer Center, designated by the National Cancer Institute as a Comprehensive Cancer Center (the nation's highest designation); and MacDonald Women's Hospital, Ohio's only hospital for women. For more information, go to www.uhhs.com.
Case Western Reserve University is among the nation's leading research institutions. Founded in 1826 and shaped by the unique merger of the Case Institute of Technology and Western Reserve University, Case is distinguished by its strengths in education, research, service, and experiential learning. Located in Cleveland, Case offers nationally recognized programs in the Arts and Sciences, Dentistry, Engineering, Law, Management, Medicine, Nursing, and Social Sciences. The Commission on Presidential Debates selected Case to host the U.S. vice presidential debate on October 5, 2004. http://www.case.edu.
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