Original Article Quetiapine in the treatment of rapid cycling bipolar disorder Quetiapine is an atypical antipsychotic that has proven to be efficacious in the treatment of schizo- phrenia with a rather benign side-effect profile (1, 2). Controlled data on the treatment of bipolar disorder with this drug are not available yet, but Ghaemi and Katzow (3) have published good results with six treatment resistant patients, and Zarate et al. (4), in a retrospective study, analysed the quetiapine response in a heterogeneous group of psychotic patients. Among all of them, bipolar patients sustained the highest response rate. Finally, Sajatovic et al. (5) found quetiapine to be effective in bipolar patients who were sub-optimally responsive to mood-stabilizers alone. Given the scant data regarding the use of quetiapine in bipolar disorder, the present study was designed to assess the short and long-term impact of add-on quetiapine in rapid cycling bipolar patients. Patients and methods After giving informed consent, 14 DSM-IV rapid cycling bipolar patients participated in this study. Vieta E, Parramon G, Padrell E, Nieto E, Martinez-Ara´n A, Corbella B, Colom F, Reinares M, Goikolea JM, Torrent C. Quetiapine in the treatment of rapid cycling bipolar disorder. Bipolar Disord 2002: 4: 335–340. ª Blackwell Munksgaard, 2002 Introduction: This prospective open-label study assessed the impact of add-on quetiapine in the treatment of rapid cycling bipolar patients. Methods: Fourteen rapid cycling bipolar patients were treated with quetiapine, which was added to their ongoing medication regimen for 112 ± 33 days. At the beginning of the study, five were manic, three were in a mixed state, three were depressed, two hypomanic and one was euthymic. Patients were assessed prospectively with a modified version of the Clinical Global Impression Scale for Bipolars (CGI-BP), the Young Scale for mania (YMRS) and the Hamilton Scale for Depression (HDRS). Results: A significant reduction of the following scale scores was observed: • a 1.8 point reduction for the general CGI-BP (p ¼ 0.013), • a –1.3 point for the mania subscale (p ¼ 0.016), • a –1.01 point for the YMRS (p ¼ 0.025). Improvement in depressive symptoms was not significant, neither in the CGI-BP (–1 point, p ¼ 0.074) nor in the HDRS (–5.2 points, p ¼ NS). The most common side-effect was sedation (n ¼ 6, 43%). Doses of quetiapine were significantly reduced by the end of the study (443 ± 235 mg/day versus 268 ± 190 mg/day, p ¼ 0.008) and they also differed according to the initial episode to be treated (720 ± 84 mg/day for mania, and 183 ± 29 mg/day for depression, p ¼ 0.023). Conclusions: Quetiapine could possibly be an effective treatment for rapid cycling bipolar patients. Adequate doses for acute episodes could significantly differ according to the episode polarity and the length of treatment. Eduard Vieta, Gemma Parramon, Elena Padrell, Evaristo Nieto, Anabel Martinez-Ara ´n, Barbara Corbella, Francesc Colom, Maria Reinares, Jose M Goikolea and Carla Torrent Bipolar Disorders Program, Hospital Clı ´nic, University of Barcelona, Barcelona, Spain Key words: bipolar disorder – clinical trial – mania – quetiapine – rapid cycling Received 4 September 2001, revised and accepted for publication 28 February 2002 Corresponding author: Dr Eduard Vieta, Hospital Clı ´nic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain. Tel.: +34 93 2275401; fax: +34 93 2275477; e-mail: evieta@clinic.ub.es Bipolar Disorders 2002: 4: 335–340 Copyright ª Blackwell Munksgaard 2002 BIPOLAR DISORDERS ISSN 1398-5647 335