30%- 55% of major depression patients achieve remission state at the end of acute SSRI or SNRI treatment. Dropout rates due to adverse events are relatively high in these trials. Quetiapine’s active metabolite, N-desalkylquetiapine (norquetiapine) is a potent inhibitor for norepinephrine transporter (like SNRI or TCA) and has moderate-to-high affinity for D2, 5HT1A, 5HT2A, and 5HT2C receptors (like SSRIs).
Previous studies has shown that Quetiapine reduced depressive symptoms in schizophrenic patients and bipolar depression.This metaanalysis is asking the question: is Quetiapine an antidepressant?
Randomized, placebo-controlled trials of quetiapine monotherapy in adults (18-65 years old) with major depression published during 1991- 2012 were included in this analysis.From the 168 citations initially identified, only 3 met all inclusion criteria.Study periods of the three trials ranged from 8 to 11 weeks. Of the 1,497 participants, none of them had treatment-resistant depression.
The pooled response rate in quetiapine group was superior to placebo ( 51.5% vs 37.55%). Remission rate of quetiapine treated group was 27.3% compared to 21% in placebo. The remission rate is lower compared to antidepressant trials. However the placebo response is also lower in the studies included in this analysis.The pooled discontinuation rate due to adverse events in the quetiapine group was significantly higher than that of the placebo group.
limitations: Different doses were used in the included studies. All studies are Pharma funded.
The findings are not far from a recent Cochrane review (Second-generation antipsychotics for major depressive disorder and dysthymia (Review):Komossa K et al, 2012). Against placebo,in major depression, all data on efficacy indicated a benefit for quetiapine. However, Acceptability of treatment ie quetiapine was poorer. More participants left early due to adverse effects (11% in the quetiapine versus 5% in the placebo group).When compared against antidepressants? Quetiapine did not show beneficial effects against a fixed dose of 60 mg/day of duloxetine. When used as an augmenting agent? more response than when augmented with placebo. I appears that there is some antidepressant effect , but not enough to be used as monotherapy in depression.
Summary of the article: Quetiapine monotherapy in acute phase for major depressive disorder: a meta-analysis of randomized, placebo-controlled trials.Maneeton N, Maneeton B, Srisurapanont M, Martin SD.BMC Psychiatry. 2012 Sep 27;12(1):160. Full text:http://www.biomedcentral.com/content/pdf/1471-244X-12-160.pdf
Dr Manoj Therayi Kumar
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