Quetiapine for Bipolar Disorder

Key Messages

What Is the Issue?

• Pharmacological treatments used for bipolar disorder include mood stabilizers (e.g., lithium, valproate), atypical (second generation) antipsychotics (e.g., quetiapine, lurasidone, cariprazine, olanzapine, aripiprazole, ziprasidone), either alone or in combination, as well as the occasional addition of antidepressants or benzodiazepines.
• Decision-makers are interested in understanding quetiapine’s place in therapy compared with other medications for the treatment of bipolar disorder in adults.

What Did We Do?

• We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2020.

What Did We Find?

• Clinical evidence suggests that quetiapine and lithium have similar efficacy and safety for the treatment of bipolar depression in adults. Quetiapine appears to be efficacious for the treatment of bipolar depression in adults despite its adverse effects, such as somnolence and weight gain.
• Evidence-based guidelines recommend the use of antipsychotics (including quetiapine), either as monotherapy or in combination with a mood stabilizer, for both the treatment and maintenance of mania (or hypomania) and bipolar depression. The choice of antipsychotic should be guided by patient preference and past response to therapy.

What Does This Mean?

• Quetiapine, among other antipsychotics, could be used as first-line treatment option for the management of bipolar disorder in adults.
• The prescribing of antipsychotics (either alone or in combination with a mood stabilizer) for the management of bipolar disorder should be guided by patient characteristics, patient tolerability, patient values, side effect profiles of individual antipsychotic medications, and clinician expertise.