Role of Quetipaine in Mood Disorders

1. Honorary Medical Officer
Department of Psychiatry
Dhaka Medical College Hospital
ROLE OF QUETIAPINE IN
MOOD DISORDER
DR. LISANUL HASAN

2. QUETIAPINE
SEROTONIN DOPAMINE ANTAGONIST;
SECOND-GENERATION
ANTIPSYCHOTIC;
ALSO A MOOD STABILIZER

3. Quetiapine’s pharmacological and binding profile

4. Quetiapine does not actually have particularly
potent binding at D2 receptors.
Quetiapine’s prominent H1 antagonist
properties probably contribute to its ability to
enhance sleep

5. Daytime sedation, especially combined with M1
antimuscarinic and α1-adrenergic antagonist
properties.
A potentially important active metabolite of
quetiapine, norquetiapine, may contribute
additional actions at receptors

6. 5HT1A partial agonist actions
Norepinephrine transporter (NET) inhibition
5HT2C, α2, and 5HT7 antagonist actions
5HT2C antagonist actions
H1 antagonist actions.
Improves mood by-
Weight gain by-

8. MOOD DISORDERS
Depressive Disorders
Bipolar Disorder

9. INDICATIONS OF QUETIAPINE
Acute schizophrenia in adults
Schizophrenia maintenance therapy: 13–
17 years
Acute mania in adults and ages 10–17
years.
Bipolar maintenance therapy.
Bipolar depression.
Depression.
FDA Approved for-
1.
2.
3.
4.
5.
6.

10. INDICATIONS OF QUETIAPINE
(OFF -LABEL)
6.Other psychotic disorders
7. Mixed mania
8.Behavioral disturbances in dementias
9.Behavioral disturbances in Parkinson’s
disease and Lewy body dementia
10.Psychosis associated with levodopa
treatment in Parkinson’s disease

11. INDICATIONS OF QUETIAPINE
(OFF -LABEL)
11.Behavioral disturbances in children and
adolescents
12.Disorders associated with problems
with impulse control
13. Severe treatment-resistant anxiety

12. ROLE OF QUETIAPINE
Robust efficacy in all aspects of bipolar
disorders, including prevention of bipolar
depression.
It has low propensity for EPSEs, though
significant effects on weight and metabolic
profile.
Many bipolar patients may experience a
reduction of symptoms by half or more

13. ROLE OF QUETIAPINE
Continue treatment until reaching a plateau
of improvement.
After reaching a satisfactory plateau,
continue treatment for at least a year after
first episode of psychosis.
For second and subsequent episodes of
psychosis, treatment may need to be
indefinite.
Treatment may not only reduce mania but
also prevent recurrences of mania in bipolar
disorder

14. HOW LONG UNTIL IT WORKS
Psychotic and manic symptoms can
improve within 1 week, but it may take
several weeks for full effect on behavior
as well as on cognition and affective
stabilization
Classically recommended to wait at least
4–6 weeks to determine efficacy of drug,
but in practice some patients require up
to 16–20 weeks to show a good
response.

15. HOW LONG UNTIL IT WORKS
Approved for long-term maintenance in
schizophrenia and bipolar disorder, and
often used for long-term maintenance in
various behavioral disorder

16. SIDE EFFECTS OF QUETIAPINE
Dose-dependent weight gain
May increase risk for diabetes and
dyslipidemia
Dizziness, sedation
Dry mouth
Constipation
Notable Side Effects :

17. SIDE EFFECTS OF QUETIAPINE
(CONTD.)
Dyspepsia
Abdominal pain
Tachycardia
Orthostatic hypotension, usually during
initial dose titration
Theoretical risk of tardive dyskinesia
Notable Side Effects :

18. SIDE EFFECTS OF QUETIAPINE
(CONTD.)
Mechanism of Actions of Side Effects :
• By blocking histamine 1 receptors in the
brain, it can cause sedation and possibly
weight gain
• By blocking alpha 1 adrenergic receptors,
it can cause dizziness, sedation, and
hypotension
• By blocking muscarinic 1 receptors, it can
cause dry mouth, constipation, and
sedation
• By blocking dopamine 2 receptors in the
striatum, it can cause motor side effects
(rare)

19. DOSING AND USE
400–800 mg/day in 1 or 2 doses for
bipolar mania
300 mg once daily for bipolar depression
Initiate in twice daily doses, totaling 100
mg/day on day 1, increasing to 400 mg/day
on day 4 in increments of up to 100
mg/day; further dosage adjustments up to
800 mg/day by day 6 should be in
increments of no greater than 200 mg/day
Usual Dosage Range
How to Dose

20. DOSING AND USE
Bipolar depression-once daily at bedtime;
titrate as needed to reach 300 mg/day by
day 4
Initial target dose of 400–800 mg/day should
be reached in most cases to optimize the
chances of success in treating acute
psychosis and acute mania, but many
patients are not adequately dosed in clinical
practice
How to Dose

21. DOSING AND USE
Higher doses generally achieve greater
response for manic or psychotic
symptoms
In contrast, some patients with bipolar
depression may respond well to doses
less than 300 mg/day and as little as 25
mg/day
Dosing in major depression may be even
lower than in bipolar depression, and
dosing may be even lower still in GAD
How to Dose (Contd.)

22. No dose adjustment required for patient
with renal impairment.
Downward dose adjustment may be
necessary for patient with hepatic
impairment.
Drug should be used with caution because
of risk of orthostatic hypotension
DOSE ADJUSTMENT

23. DOSING (PREGNANCY AND LACTATION)
Quetiapine may be preferable to
anticonvulsant mood stabilizers if
treatment is required during
pregnancy
Relative low rate of placental
passage
Unknown if quetiapine is secreted in
human breast milk.
Infant plasma concentration-
Undetectable
How to Dose (Contd.)

24. Thank you

25. References:
*Shorter Oxford Textbook of Psychiatry
*Stahl's Essential Psychopharmacology
*Stahl's Essential Psychopharmacology- Prescriber's Guideline
*The Maudsley Prescribing Guideline in Psychiatry