The effect of add-on treatment with quetiapine on measures of depression, aggression, irritability and suicidal tendencies in children and adolescents

Abstract

Rationale Atypical antipsychotics are frequently prescribed for psychotic and mood disorders in youth, and for symptoms of depression, aggression, irritability and suicidal tendencies, which are associated with subsequent development of borderline personality disorders (BPD). ----- Objectives This study evaluated the effects of 24-weeks of add-on treatment with quetiapine to selective serotonin reuptake inhibitors (SSRIs) in young people with pronounced symptoms of depression, aggression, irritability and suicidal tendencies. ----- Methods In an open-label 24-weeks trial, 22 SSRI-treatment resistant patients (age range 9-18 years) with developing BPD were treated with quetiapine (75-600 mg/day) in combination with SSRIs. Symptoms of depression, aggression, irritability and suicidal tendencies were rated with the Overt Aggression Scale Modified (OAS-M), Kutcher Adolescent Depression Scale (KADS-6) and Children Global Assessment Scale (C-GAS) before and after 4-24 weeks of treatment. ----- Results Quetiapine induced significant (p<0.001) improvement after 4-24 weeks, with a modest but significant increase in the C-GAS total scores (i.e. children’s general clinical status), and a significant reduction of the total scores in OAS-M, KADS-6 and OAS-M subscales for aggression, irritability and suicidality. There were no discontinuations for adverse effects. Conclusions These preliminary results suggest that quetiapine addition to SSRIs treatment significantly reduced symptoms of depression, aggression, irritability and suicidal tendencies in young people with developing BPD.