Quetiapine monotherapy versus placebo in the treatment of children and adolescents with bipolar depression: a systematic review and meta-analysis

Abstract

BackgroundSome studies have indicated the efficacy of quetiapine in the treatment of bipolar depression in adult patients. However, its efficacy has been not shown in child and adolescent patients.ObjectiveThis systematic review purposefully determined the efficacy and acceptability of quetiapine in the treatment of children and adolescents with bipolar depression.Data sourcesA database search of EMBASE, PubMed, CINAHL, and Cochrane Controlled Trials Register was carried out in March 2016. All randomized controlled trials (RCTs) of bipolar depression in children and adolescents were considered for inclusion in this review.Study eligibility criteria, participants, and interventionsRCTs of quetiapine in the treatment of child and adolescent patients with bipolar depression with end point outcomes were included in this study. Languages were not limited.Study appraisal and synthesis methodsThe full-text versions of relevant clinical studies were thoroughly examined and extracted. The primary efficacy of outcome was measured by using the pooled mean-changed scores of the rating scales for bipolar depression. However, the response and remission rates were also measured.ResultsA total of 251 randomized patients in the three RCTs of quetiapine versus placebo in the treatment of bipolar depression for children and adolescents were eligible in this review. The pooled mean-changed score of the quetiapine-treated group was not greater than that of the placebo-treated group. Similarly, the pooled response and remission rates were not different between the two groups. The pooled overall discontinuation rate and the discontinuation rate due to adverse events were not different between the two groups.LimitationsLimited studies were eligible in this review.ConclusionAccording to the findings in this review, quetiapine may not be efficacious in the treatment of bipolar depression in children and adolescents. Its acceptability, however, was comparable to a placebo. Therefore, the use of quetiapine in children and adolescents with bipolar depression is not recommended. Further well-defined clinical studies should be performed to confirm these outcomes.

Low-Dose Quetiapine Fumarate (50 mg) for Obsessive-Compulsive Disorder Patients With Comorbid Bipolar Depression

“…A meta-analysis revealed that quetiapine fumarate (50 mg and 150 mg) is indeed efficacious in acute treatment of adult patients with generalized anxiety disorder. 8 The positive effect of quetiapine on sleep disturbances observed in all our patients may explain its beneficial effect on 9 It is implausible that long-term SSRI treatment accounted for the positive antidepressant effect, because all patients developed BP-D despite continuous SSRI exposure. Moreover, limited therapeutic utility of SSRIs in BP-D and a detrimental effect on the course of BP were reported.…”

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

“…For antipsychotics, we included three NMAs 101‐103 , 11 MAs 104‐114 , 25 individual RCTs 115‐139 also included in those NMA/MAs, three additional RCTs 140‐142 , and two cohort studies 99,143 . There were 66,764 youth on antipsychotics, including 7,712 across 53 RCTs after eliminating duplicated RCTs in multiple NMA/MAs (6,725 in NMA/MAs, 987 in additional RCTs), and 59,052 in two cohort studies.…”

Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review

“…We ultimately included 14 NMAs and 90 MAs, reporting on 15 disorders or groups of disorders. For ADHD, we included three NMAs 5,20,21 and 21 MAs 22‐42 ; for autism, one NMA 43 and 21 MAs 12,44‐63 (including one focusing on comorbid anxiety disorders and autism) 12 ; for depressive disorders, two NMA 7,10 and seven MAs 64‐70 ; for obsessive‐compulsive disorder, one NMA 71 and six MAs 72‐77 ; for anxiety disorders, two NMAs 11,78 and five MAs 12,79‐82 (plus two MAs specific on social anxiety disorder 83,84 ); for enuresis, one NMA 85 and six MAs 86‐91 , for disruptive behavior/dissocial/conduct disorders, five MAs 92‐96 (plus one focusing on youth with comorbid ADHD) 25 ; for eating disorders, one NMA 97 and four MAs 98‐101 ; for schizophrenia spectrum disorders, three NMAs 8,102,103 and two MAs 104,105 ; for bipolar disorder, four MAs 106‐109 ; for tic disorder, two MAs 110,111 ; for Tourette's disorder, two MAs 112,113 ; for encopresis, two MAs 114,115 ; for developmental coordination disorder, one MA 116 ; and for PTSD, one MA 117 .…”