Posted by Bill LL on November 8, 2005, at 15:56:38
In reply to Re: Need some support on Lamictal » Bill LL, posted by Phillipa on November 7, 2005, at 18:15:20
Hi Phillipa - I agree with you. It's not really an antidepressant per se. But I have seen a couple of articles about it. If you read the stuff I pasted below, things are a bit murky. The first guy was apparently funded by the manufacturer of Seroquel. And the second guy was talking about Seroquel supplementation to other drugs. So I don't really know for sure.
http://www.psycheducation.org/depression/meds/quetiapine.htm1. New evidence has been presented showing quetiapine has antidepressant effects. These effects were quite substantial in this new study. In addition, the design of this study is more solid than some of the other medications studies out there, in that patients were not pre-selected for having "tolerated" quetiapine. Everyone who was randomized to get quetiapine had never been on it. That's different than some of the "long-term" data, meaning more than a few weeks, in other studies such as lamotrigine, where the patients who entered the study had already been on the medication, at least for a few weeks, thus selecting patients who could get on and stay on it. In the quetiapine study, this favorable bias was not present.
How much antidepressant effect? It looks like a lot, based on the reports from this study released so far. The main investigator, Dr. Calabrese, also headed the studies of lamotrigine which showed striking antidepressant effects for that drug. So, he is not new to this area of bipolar disorder, that's for sure. But, he exclaimed, (mind you, he has surely been funded handsomely for his work with this company):
"This is the first time that an antipsychotic has been shown to have clear antidepressant activity," senior investigator Joseph R. Calabrese, MD, told Medscape in a telephone interview. "Treatment separated from placebo on every outcome. I was surprised to see how large the effect was. It seems to me that this drug is not just an antipsychotic. It separated from placebo on nine of 10 items, compared to olanzapine, which separates from placebo in three items when assessed as a treatment for bipolar depression."Medscape
(For you skeptics, who wonder about Dr. Phelps and his possible funding by AstraZeneca -- good on 'ya for wondering! I just started receiving $ from them yet after working on it for almost a year, as their point of view may allow me to promote my point of view using their money. Here's my full explanation of how I handle that.)
UPDATE 7/05: Another "real world" research study, with a very long period of observation, was just published.Hardoy This was not "blinded", meaning that both the patients and the doctors knew that Seroquel was being used. However, this study looked at the course of illness when Seroquel was added to other medications, which is how we often end up using it. Although system used to evaluate results was rather crude, it is similar to what doctors like me do: we basically ask ourselves "Is the patient better? How much?" The results were strong, even though there weren't many patients in the study (21; usually a small sample like this makes it harder to find "statistically significant" results). Relapse rates into some kind of bipolar symptom, including depression, were three times lower with Seroquel compared to before it was added. If we were to find these kind of results in a long-term trial that was randomized to start, as we have for Zyprexa, then this kind of result would be very impressive. For now, however, it adds just a little more reliability to the impression we doctors who use the stuff have developed: it does indeed seem to work pretty well over time, not just at first. Remember, that's the "holy grail", for now, amongst mood stabilizers -- does it work long term?
2. The second feature of quetiapine that distinguishes it from some of the other "atypical antipsychotic" options is a possible lower risk of causing weight gain and diabetes, at least compared to Zyprexa. [Update October 2004: a recent direct study of this issue confirms this relative risk, consistent with the table belowLeslie; although another study does not.Citrome]
> Bill don't know how you can say seroquel acts as an antidepressant. It is atypical antipsycotic and all it did for me was make me feel drunk. Maybe I misinterpreted your message. Let me know if I did. Fondly, Phillipa
poster:Bill LL
thread:575874
URL: http://www.dr-bob.org/babble/20051106/msgs/576796.html