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| |  Quetiapine a Treatment Option for Patients With Treatment-Resistant Depression: Presented at EPA By Jenny Powers MUNICH, Germany -- March 2, 2010 -- Quetiapine extended release (XR) is a better treatment option for patients with treatment-resistant depression than lithium plus ongoing antidepressant treatment (ADT), according to a study presented at the European Psychiatric Association (EPA) 18th European Congress of Psychiatry. Stuart Montgomery, MD, Imperial College School of Medicine, London, United Kingdom presented the study results here on February 28, which showed quetiapine noninferior to lithium plus ADT in patients with stage 2 treatment resistance. Stage 1 resistance is defined as failure of >=1 antidepressant and stage 2 is defined as failure of >= 2 antidepressants. The primary efficacy variable was change from baseline to week 6 in total Montgomery-Asberg Depression Rating Scale (MADRS) score, and the primary study objective was evaluation of the efficacy of quetiapine monotherapy and quetiapine plus ADT compared with lithium plus ADT. A total of 688 patients were randomised to receive quetiapine XR 300 mg/day plus selective serotonin reuptake inhibitors or venlafaxine (n = 231), quetiapine XR alone (n = 229), or lithium plus ADT (n = 229) for 6 weeks. The intent-to-treat population consisted of 229 in the quetiapine/ADT group, 225 patients in the quetiapine monotherapy group, and 221 patients in the lithium/ADT groups. Both quetiapine plus ADT and quetiapine monotherapy were not inferior to lithium plus ADT in the primary (per protocol) analysis with a mean difference on the MADRS of -2.32 (97.5% confidence interval [CI], -4.6 to -0.05) favouring add-on quetiapine and -0.97 (97.5% CI, -3.24 to 1.31) favouring quetiapine monotherapy. Quetiapine XR plus ADT was significantly more effective than lithium plus ADT on the MADRS change from baseline (P = .046). The advantage was observed at day 4 (P = .007). Quetiapine XR plus ADT showed a greater advantage over lithium plus ADT in patients with stage 2 resistance. The researchers also found that there was an early significant and persistent efficacy advantage on MADRS for quetiapine augmentation compared with lithium augmentation of selective serotonin reuptake inhibitors or venlafaxine treatment. “The results are complex but the simple conclusion is that quetiapine treatment is better than lithium,” said Dr. Montgomery. Funding for this study was provided by AstraZeneca Pharmaceuticals. [Presentation title: Quetiapine XR or Lithium Combination With Antidepressants in Treatment Resistant Depression. Abstract P01-75]
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