September 2008

ECGs for Kids with ADHD?
An electrocardiogram may be advisable for some children before they begin pharmacologic treatment for attention-deficit/hyperactivity disorder.

Valproate for Agitation in Dementia
In two studies, valproate (Depakote and others) did not seem to decrease agitation and aggression in patients with dementia.

Topiramate in the Treatment of Borderline Personality Disorder
Preliminary research suggests topiramate may be useful in the treatment of borderline personality disorder.

In Brief
Generic Risperidone Now Available; Ginkgo biloba Not Effective for Dementia; Autism Linked to Defects in “Learning” Genes

Quetiapine Augmentation in GAD: A Negative Trial
In a recent study, augmenting paroxetine (Paxil and others) treatment of generalized anxiety disorder with quetiapine (Seroquel) was ineffective.

BTP Announces ASCP Partnership
BTP proudly announces our partnership with the American Society of Clinical Psychopharmacology (ASCP) and extends a warm welcome to all ASCP members.

Quetiapine Augmentation in GAD: A Negative Trial

September 2008

In February (BTP 2008;31:6-8), we presented results of a double-blind trial by Chouinard and collaborators, who compared extended-release quetiapine (Seroquel XR) monotherapy, 50 or 150 mg/day; paroxetine (Paxil and others), 20 mg/day; and placebo for 8 weeks in patients with generalized anxiety disorder (GAD).1 Both doses of quetiapine appeared comparable to paroxetine, and both drugs were superior to placebo. More patients taking quetiapine dropped out due to adverse effects, particularly somnolence.

In another study of patients with GAD, Simon and coauthors prescribed open-label paroxetine continued-release (Paxil CR), flexibly dosed up to 62.5 mg/day, for 10 weeks.2 Subjects who remained symptomatic were randomly assigned to adjunctive treatment with quetiapine, flexibly dosed to a maximum of 400 mg/day, or placebo in addition to continued treatment with paroxetine.

With open-label paroxetine treatment, 58% of patients were considered responders, and 40% achieved remission. Twenty-two patients remained sufficiently symptomatic to go on to the double-blind, randomized portion of the study, but almost half of the patients who received quetiapine dropped out. Reasons included weight gain, sedation, and akathisia. In the small remaining patent sample, there was no added benefit for augmenting paroxetine with quetiapine compared with placebo.

As we noted in February's article, antipsychotics should be reserved for difficult cases of GAD. Should quetiapine be added to an SSRI for some such cases? The "jury" is still out.

1Chouinard G, Bandelow B, Ahokas A, Eggens I, Liu S, Brecher M: Once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy in generalized anxiety disorder: A phase III, double-blind, placebo-controlled study. Poster presented at the 46th annual meeting of the American College of Neuropsychopharmacology, Boca Raton, FL, December 9-13, 2007.

2Simon NM, Connor KM, LeBeau RT, Hoge EA, Worthington JJ III, Zhang W, Davidson JRT, Pollack MH: Quetiapine augmentation of paroxetine CR for the treatment of refractory generalized anxiety disorder: Preliminary findings. Psychopharmacology 2008;197:675-681.