Department of Psychiatry, Fernand-Seguin Research Centre, Université de Montréal, Canada.
Int Clin Psychopharmacol. 2011 Jul;26(4):183-92. doi: 10.1097/YIC.0b013e3283430a0e.
The atypical antipsychotic, quetiapine, is frequently prescribed on-label and off-label for the treatment of a variety of psychiatric disorders. As quetiapine has variable affinity for dozens of receptors, its clinical effects should also show a large variation as a function of dose and diagnostic category. This study attempts to elucidate the dose-response and comparative efficacy and tolerability (metabolic data) of quetiapine across psychiatric disorders. A systematic search was carried out in the electronic databases, PubMed and EMBASE, using the keywords 'quetiapine' and 'placebo'. Both monotherapy and add-on studies were included. A total of 41 studies were identified. In unipolar and bipolar depression, studies consistently found quetiapine to be effective versus placebo, at doses of approximately 150-300 and 300-600 mg per day, respectively. In bipolar mania, they consistently found quetiapine to be effective at doses of approximately 600 mg per day. In acute exacerbation of schizophrenia, the majority of studies found quetiapine to be effective at doses of approximately 600 mg per day; however, a few large studies found no difference versus placebo. In contrast, studies consistently found quetiapine to be more effective than placebo for stable schizophrenia. In obsessive-compulsive disorder, studies did not consistently find quetiapine to be effective at doses of approximately 300 mg per day. However, studies may have underestimated the efficacy of quetiapine for obsessive-compulsive disorder due to concomitant administration of antidepressants and the utilization of treatment-refractory patients. In generalized anxiety disorder, studies consistently found quetiapine to be effective at doses of approximately 150 mg per day. Finally, analysis of metabolic tolerability data suggests that even low doses of quetiapine may lead to increase in weight and triglycerides across psychiatric disorders. Interestingly, however, quetiapine-induced elevations in low-density lipoprotein and total cholesterol seem to be restricted to schizophrenia patients.
非典型抗精神病药喹硫平通常被规定用于治疗多种精神疾病的适应证内和适应证外。由于喹硫平对数十种受体具有不同的亲和力，其临床效果也应根据剂量和诊断类别而有很大差异。本研究试图阐明喹硫平在各种精神障碍中的剂量反应、比较疗效和耐受性（代谢数据）。我们在电子数据库 PubMed 和 EMBASE 中使用了“喹硫平”和“安慰剂”这两个关键词进行了系统搜索。纳入了单药治疗和附加治疗的研究。共确定了 41 项研究。在单相和双相抑郁中，研究一致发现，喹硫平在每天约 150-300 毫克和 300-600 毫克的剂量下对安慰剂有效。在双相躁狂中，研究一致发现，喹硫平在每天约 600 毫克的剂量下有效。在精神分裂症急性恶化中，大多数研究发现喹硫平在每天约 600 毫克的剂量下有效；然而，少数大型研究发现喹硫平与安慰剂相比没有差异。相比之下，研究一致发现，在稳定的精神分裂症中，喹硫平比安慰剂更有效。在强迫症中，研究并不一致地发现喹硫平在每天约 300 毫克的剂量下有效。然而，由于同时使用抗抑郁药和利用难治性患者，研究可能低估了喹硫平对强迫症的疗效。在广泛性焦虑症中，研究一致发现喹硫平在每天约 150 毫克的剂量下有效。最后，对代谢耐受性数据的分析表明，即使喹硫平的低剂量也可能导致各种精神障碍中体重和甘油三酯的增加。有趣的是，然而，喹硫平引起的低密度脂蛋白和总胆固醇升高似乎仅限于精神分裂症患者。
