Quetiapine in the treatment of psychotic depression: A pilot study

Introduction: Quetiapine is an approved atypical antipsychotic in the treatment of schizophrenia and bipolar depression. It was assumed that Quetiapine show similar effects in psychotic depression. Method: In a 6-week, open-label pilot study we planned to investigate the efficacy of Quetiapine in reducing depressive symptoms in 20 depressive patients with psychotic features (ICD-10:F32/3.3) using the Montgomery-Asberg Depression Rating Scale (MADRS) as primary endpoint. Secondary efficacy variables were the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Brief Psychiatric Rating Scale (BPRS) but also to evaluate the safety and tolerability. Patients received a flexible dose of Quetiapine (sustained release) monotherapy with at least 300 mg/d. Results: Out of 59 eligible patients 16 participants (9 m, 7f; 43.3 ± 9.3 years) were finally included with a discontinuation of 5 patients. Taking a mean end dosage of 495.45 ± 154.41 mg/d Quetiapine the MADRS decreased significantly (p < 0.000) in all completing patients from 33.40 ± 9.38 to 12.00 ± 8.60 over time. There were also significant improvements (0.034<p < 0.001) in the PANSS (positive, negative, general), GAF, and BPRS. The mean change of individual body weight (LOCF) was 2.09 ± 2.07% (p < 0.014). No serious adverse events occurred. Discussion: Quetiapine appears to be effective and safe in psychotic depression – especially for depressive symptoms as well as for some general psychopathological dimensions.