Prevenirea recăderilor în tulburarea bipolară tip I: studiu comparativ pe 18 luni între monoterapia cu Quetiapina vs. Quetiapina-Valproat

Abstract

Background. Few controlled studies have examined the use of atypical antipsychotic drugs for the prevention of relapse in patients with bipolar I disorder. Aims. We tried to evaluate whether quetiapine monotherapy reduces the rate of relapse, compared with combined therapy quetiapine-valproate in patients with bipolar I disorder. Method. Our study included patients in clinical remission after treatment with quetiapine and valproate which were followed for 18 months. In that period patients were divided into two groups, A and B. The A group received treatment with quetiapine monotherapy and the B group received treatment with quetiapine and valproate. The syndromic relapses were required to have the DSM-IV criteria for manic, mixed, or depressed episodes, and the symptomatic relapses were required a total score of 15 or more on YMRS or MADRS scales. Results. Long-term efficacy has not been well demonstrated for most currently available treatment regimens for bipolar disorder. The therapeutic guidelines indicate using combination therapy, most often of valproate or lithium and an antipsychotic. In our study, the treatment difference in time to relapse either mania or depression was not significant for syndromic relapse but significant for symptomatic relapse. Conclusions. In our study, patients taking quetiapine and valproate experienced sustained symptomatic remission, but not syndromic remission for longer than those receiving quetiapine in monotherapy.