A randomized pilot study of psychotherapy and quetiapine for the acute treatment of bipolar II depression

Mar 17, 2012Bipolar disorders

Psychotherapy and quetiapine for treating bipolar II depression: a small randomized study

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Abstract

Both psychotherapy and quetiapine resulted in significant declines in depression scores over 12 weeks for individuals with bipolar II disorder.

Participants in both treatment groups showed notable reductions in depression and mania scores over time.
Dropout rates were 21% for the psychotherapy group and 27% for the quetiapine group.
Overall response rates were similar, with 29% of the psychotherapy group and 27% of the quetiapine group meeting criteria for improvement.
High treatment satisfaction was reported in both groups.
No association was found between treatment preference and clinical outcomes.

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OBJECTIVES: The differential roles of psychotherapy and pharmacotherapy in the management of bipolar (BP) II depression are unknown. As a first step toward exploring this issue, we conducted a pilot study to evaluate the feasibility and acceptability of comparing a BP-specific psychotherapy [Interpersonal and Social Rhythm Therapy (IPSRT)] to quetiapine as treatments for BP-II depression.

METHODS: Unmedicated individuals (n = 25) meeting DSM-IV criteria for BP-II disorder, currently depressed, were randomly assigned to weekly sessions of IPSRT (n = 14) or quetiapine (n = 11), flexibly dosed from 25-300 mg. Participants were assessed with weekly measures of mood and followed for 12 weeks. Treatment preference was queried prior to randomization.

RESULTS: Using mixed effects models, both groups showed significant declines in the 25-item Hamilton Rating Scale for Depression [F(1,21) = 44, p < 0.0001] and Young Mania Rating Scale [F(1,21) = 20, p = 0.0002] scores over time but no group-by-time interactions. Dropout rates were 21% (n = 3) and 27% (n = 3) in the IPSRT and quetiapine groups, respectively. Overall response rates (defined as ≥ 50% reduction in depression scores without an increase in mania scores) were 29% (n = 4) in the IPSRT group and 27% (n = 3) in the quetiapine group. Measures of treatment satisfaction were high in both groups. Treatment preference was not associated with outcomes.

CONCLUSIONS: Outcomes in participants with BP-II depression assigned to IPSRT monotherapy or quetiapine did not differ over 12 weeks in this small study. Follow-up trials should examine characteristics that predict differential response to psychotherapy and pharmacotherapy.

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A randomized pilot study of psychotherapy and quetiapine for the acute treatment of bipolar II depression

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