Seroquel Works...Er, About Half the Time

As mentioned earlier, a bunch of studies came out of the European College of Neuropsychopharmacology (ECNP) Congress last week. The conference was held in Amsterdam. The nice folks at AstraZeneca, makers of Seroquel, were repping results of studies showing how their star atypical performed in bipolar disorder.

One study examined how Seroquel performed against rapid cycling, a sub-type of bipolar disorder. In the study, 108 patients who exhibited severe or moderate depression as part of their rapid cycling were randomized and given either 300 mgs. or 600 mgs. a day of Seroquel. A third of the 108 patients were given placebo. According to the company's press release, the two groups taking Seroquel had their depression improve twice as much as the group taking placebo. Also, 53 percent of patients had their symptoms of depression remit (the release doesn't so what they mean by remission) versus 27 percent of the patients taking placebo. So Seroquel worked for about half the patients who took it. In a previous post, I noted that NIMH has stated in its own documents that psych meds give symptom remission to about 50 percent of patients who take them. They did not point to that figure as cause for hope.

The efficacy trial was 8 weeks long.

You already know how I feel about using placebo in severely ill patients. Also, an 8 week study doesn't tell you shit about how Seroquel will work with rapid cyclers in the real world--ie, beyond 8 weeks. Rapid cyclers, by definition, have four episodes of mania, hypomania or depression a year. So it's highly likely that these same patients will be pressed by their docs to up their Seroquel doses once their next round of depression comes around, or mania or hypomania. That's not a happy prospect, given the heavy head and weight gain, etc. that comes with Seroquel. And there's not much higher the docs can go with Seroquel in this population. Top level doses of Seroquel typically run 800-900 mgs. a day.

It's nice that Seroquel works in an 8-week trial. But I and many other bpers I know, who fall loosely into the same patient class, have found that Seroquel works fairly well initially, but that it poops out over time. And, then, our docs want to boost the doses even higher until the side effects blossom--and you are fucked up and knocked to the ground. Then it's on to the next med. So I don't find this study impressive in the least.

I just love this psychopharmacology revolution, don't you?