Quetiapine in the Anxiety Dimension of Mood Disorders

Abstract

Purpose/Background: Bipolar disorder and major depressive disorder are heterogeneous conditions characterized by marked variations in mood. High levels of anxiety are often present in these conditions and are associated with increased suicidal risk, increased disease duration, and treatment resistance. Mood stabilizers or antipsychotics are recommended for the treatment of bipolar disorder in comorbidity with anxiety disorders. This study examines current knowledge to evaluate the efficacy of quetiapine in the treatment of anxiety in mood disorders.Methods/Procedures: A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting randomized control trials that evaluated the efficacy of quetiapine on anxiety symptoms in patients diagnosed with bipolar disorder or major depressive disorder and included anxiety evaluation scales.Findings/Results: We collected 27 studies (19 with primary data analysis, 8 with secondary data analysis) regarding the use of quetiapine in mood disorders. Quetiapine was more effective than placebo and active comparators in reducing anxiety in unipolar and bipolar patients in 20 of these studies. In 7 studies, quetiapine was not superior to psychoactive comparators or placebo on the anxiety dimension.Implications/Conclusions: Statistical power might be limited by small sample size in 5 of the studies included in our review. Moreover, data on anxiety were a secondary outcome in most studies. Nevertheless, the reported studies show with good levels of concordance that quetiapine is effective in controlling anxiety symptoms in patients with mood disorders. This evidence supports current guidelines and recommendations concerning the use of quetiapine in clinical practice.

Antipsychotic agents in anxiety disorders: An umbrella review

“…Several antipsychotics are approved for use as augmentation treatment for patients with unipolar and bipolar depression 61,72 . Patients who have both anxiety and depression may be more responsive to the addition of low‐dose antipsychotic agents in effort to manage both mood and anxiety symptoms, 72,73 especially for those who do not respond to the first line antidepressant pharmacotherapy 74 . Additionally, the 5‐HT 1A partial agonist and H‐1 antagonist activity of agents like olanzapine and quetiapine may help explain their greater efficacy in anxiety and panic 55 .…”

Serotonin and dopamine depletion in distinct brain regions may cause anxiety in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-treated mice as a model of early Parkinson’s disease

“…SSRIs, commonly used to treat anxiety disorders, are thought to exert their therapeutic effect by blocking 5-hydroxytryptamine reuptake via the serotonin transporter system. In clinical practice, SSRIs have poor effects on some patients with anxiety disorders for whom low-dose dopamine receptor antagonists alleviate anxiety symptoms [ 37 ]. This suggests that dopaminergic mechanisms may also be important as the 5-hydroxytryptamine and dopamine systems have bidirectional influences on each other.…”

Inhibition of HCN1 currents by norquetiapine, an active metabolite of the atypical anti-psychotic drug quetiapine

“…Consequently, AAPs are being used more often in recent years to treat anxiety, MDD, PTSD and other disorders. Quetiapine (QTP), a second-generation AAP commonly prescribed for the treatment of schizophrenia (Dev & Raniwalla, 2000;Small et al, 1997) and acute bipolar mania (Janicak & Rado, 2012), is now also used to treat insomnia (Lin et al, 2023), MDD (Ravindran et al, 2022), anxiety (Bandelow et al, 2010;Crapanzano et al, 2021;Ravindran et al, 2022), and PTSD (Crapanzano et al, 2023). Like other AAPs, QTP is structurally similar to clozapine and acts as an antagonist to serotonin, dopamine, histamine, and adrenergic receptors (Burns, 2001;Saller & Salama, 1993).…”

“…Quetiapine fumarate (Seroquel®) (QTP) is a second-generation atypical antipsychotic drug that has been commonly prescribed for the treatment of schizophrenia (Dev & Raniwalla, 2000;Small, Hirsch, Arvanitis, Miller, & Link, 1997), acute bipolar mania (Janicak & Rado, 2012), insomnia (Lin, Chiang, Tseng, Tam, & Loh, 2023), major depressive disorder (depression) (Ravindran et al, 2022), anxiety (Bandelow et al, 2010;Crapanzano, Damiani, & Guiot, 2021;Ravindran et al, 2022), Post-traumatic stress disorder (Crapanzano, Damiani, Casolaro, & Amendola, 2023) and other psychological disorders (Saller & Salama, 1993). Like other atypical antipsychotics, QTP is structurally similar to clozapine and acts as an antagonist to serotonin, dopamine, histamine, and adrenergic receptors (Burns, 2001;Saller & Salama, 1993).…”