QUETIAPINE IS AN ATYPICAL ANTIPSYCHOTIC USED IN THE TREATMENT
OF SCHIZOPHRENIA AND SEVERE MANIC AND DEPRESSIVE EPISODES
OF BIPOLAR DISORDER.
TREATMENT OF SUBSTANCE USE DISORDERS WITH CO-OCCURRING
SEVERE MENTAL HEALTH DISORDERS
BIPOLAR AFFECTIVE DISORDER
Both mood stabilizers and atypical antipsychotics [1] have been evaluated in co-occurring substance
use and bipolar affective disorders, mainly in comorbid alcohol, cannabis and cocaine use disorders [1].
Quetiapine, a first-line medication for bipolar disorder has not been found to be effective in improving
alcohol use outcomes in a large multicentric randomized controlled trial [2]. A recent placebo
controlled trial evaluating Quetiapine XR (AstraZeneca Pharmaceuticals LP, Wilmington, DE) in
patients with bipolar depression and generalized anxiety with and without alcohol or cannabis use
found that active treatment was better than placebo in terms of reduction of depressive symptoms.
Decrease in depression scores was greater in the group with recent alcohol or cannabis use disorder
compared with those without it. However, there were no significant differences in drinking days / week
or joints of cannabis smoked/week between the active and placebo groups. This reinforces the finding
that quetiapine in this population may at best reduce depressive symptomatology but has little impact
on substance use outcomes [3].
Yet, quetiapine continues to be widely prescribed for people with SUD and comorbid mental health
disorders. A naturalistic study evaluating the efficacy of asenapine in 119 psychiatric in patients with
bipolar I disorder with and without SUD showed that patients improved on disease-related outcomes
(Young Mania Rating Scale (YMRS) and Brief Psychiatric Rating Scale) across time points. However, the
improvements in YMRS scores were greater in individuals without comorbid SUD [4].
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reatment of substance use disorders with co-occurring severe mental health disorders
1. Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of
patients with bipolar disorder. Bipolar Disord 2018; 20:97–170.
2. Stedman M, Pettinati HM, Brown ES, et al. A double-blind, placebo-controlled study with quetiapine as adjunct therapy with lithium or divalproex in bipolar I patients with coexisting alcohol dependence.
Alcohol Clin Exp Res 2010; 34:1822–1831.
3. Gao K, Ganocy SJ, Conroy C, et al. A placebo controlled study of quetiapine-XR in bipolar depression accompanied by generalized anxiety with and without a recent history of alcohol and cannabis use.
Psychopharmacology (Berl) 2017; 234:2233–2244.
4. De Filippis S, Cuomo I, Kotzalidis GD, et al. Does the efficacy of asenapine in bipolar disorder increase in the presence of comorbidity with a substance use disorder? A naturalistic study. Ther Adv
Psychopharmacol 2017; 7:67–77.
