Magazine article Clinical Psychiatry News

CEQUEL: Combo Therapy a Win in Bipolar Depression

Magazine article Clinical Psychiatry News

CEQUEL: Combo Therapy a Win in Bipolar Depression

Article excerpt

VIENNA -- Psychiatrists have received a welcome gift in the form of CEQUEL, a randomized trial that offers guidance on how to proceed when quetiapine for bipolar depression isn't achieving sufficient response, Eduard Vieta, MD, PhD, said at the annual congress of the European College of Neuropsychopharmacology.

The answer provided by CEQUEL is to add lamotrigine.

"Quetiapine is indicated for treatment of symptoms of bipolar depression, but many clinicians--including myself--are a bit underwhelmed about the practical results. In the clinical trials, quetiapine looks great, but when we use it in practice we're not so happy with the results. The trials are consistendy positive with a large effect size, whereas in clinical practice many patients respond only partially to quetiapine. The question has been what to do next," said Dr. Vieta, professor psychiatry at the University of Barcelona.

Increasing the dose of quetiapine (Seroquel) above the recommended 300 mg/day in an effort to boost efficacy is problematic. Patients become extremely sedated. The CEQUEL (Comparative Evaluation of Quetiapine Plus Lamotrigine) investigators decided to examine combination therapy with two drugs having different mechanisms of action.

A total of 202 patients with bipolar depression at 27 U.K. sites were placed on quetiapine and randomized double blind to lamotrigine or placebo. Lamotrigine (Lamictal) was started at 25 mg/day and gradually increased to 200 mg daily. …

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