Extended-release quetiapine fumarate (quetiapine XR) monotherapy and quetiapine XR or lithium as add-on to antidepressants in patients with treatment-resistant major depressive disorder

Comparative efficacy and acceptability of seven augmentation agents for treatment-resistant depression: A multiple-treatments meta-analysis

“…1). [17][18][19][20][21][22][23][24][25][26][27][28] All 12 of these studies had obtained ethical approval. Altogether, the 12 studies included 1 936 patients and seven kinds of augmentation agents, namely lithium, tricyclic antidepressants (TCAs), atypical antipsychotics (AAPs), antiepileptic drugs (AEDs), buspirone, cognitive behaviour therapy (CBT) and tri-iodothyronine (T3).…”

Study protocol for a randomised pragmatic trial comparing the clinical and cost effectiveness of lithium and quetiapine augmentation in treatment resistant depression (the LQD study)

“…Despite these recommendations, few studies have compared the efficacy of lithium versus atypical antipsychotic augmentation head-to-head [3, 20, 21]. The largest and arguably best study to date compared lithium and quetiapine extended release (XR) over just 6 weeks, and found quetiapine to be non-inferior to lithium add-on therapy in patients with TRD [20].…”

“…The largest and arguably best study to date compared lithium and quetiapine extended release (XR) over just 6 weeks, and found quetiapine to be non-inferior to lithium add-on therapy in patients with TRD [20]. Lithium versus quetiapine augmentation has also been compared in a pilot study of 20 patients, which reported significant reduction in depressive symptoms in both groups, but a greater decrease in Hamilton Depression Rating Scale (HDRS) scores from day 14 onwards in the quetiapine group [21].…”

“…Quetiapine was selected as the atypical antipsychotic comparator, as there is strong evidence for the efficacy of quetiapine augmentation versus placebo [23–25], and it is currently licenced for marketing as an add-on treatment for TRD in the UK in its XR formulation [19]. Although NICE does support the use of other atypical antipsychotics (aripiprazole, risperidone and olanzapine) as add-on treatments in TRD, and there is some evidential support for their use [17, 26], quetiapine is the only atypical antipsychotic to have been previously studied under trial conditions in a head-to-head comparison with lithium, meaning at least comparable short-term effectiveness between the two treatments under trial conditions is known [20]. While this study by Bauer and colleagues reported quetiapine to be non-inferior to lithium over a six week treatment course, there was also some indication that quetiapine may be more clinically effective than lithium.…”

“…While this study by Bauer and colleagues reported quetiapine to be non-inferior to lithium over a six week treatment course, there was also some indication that quetiapine may be more clinically effective than lithium. This included lower depression severity scores (Montgomery-Åsberg Depression Rating Scale, MÅDRS), reported as early as day 4 of treatment, and less sleep disturbance [20]. Additionally, a network meta-analysis comparing augmentation agents in TRD found lithium and quetiapine to both be more effective than a placebo, but indicated that the efficacy of quetiapine was more robust than lithium [27].…”