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The incidence of treatment-emergent mania/hypomania was lower with quetiapine compared with paroxetine and placebo. The conclusions were that quetiapine (300 or 600 mg/day), but not paroxetine, was more effective than placebo for treating acute depressive episodes in bipolar I and II disorder. Quetiapine treatment was generally well tolerated.42) Another double blind, placebo-controlled Aldosterone study evaluated the effectiveness of quetiapine extended release once daily in bipolar depression. The subjects were acutely depressed adults with bipolar I or II disorder, with or without rapid cycling. Patients were randomized to 8 weeks of quetiapine XR 300 mg daily monotherapy or placebo. The primary outcome measure was change from baseline to Week 8 in MADRS total score. The results showed that quetiapine XR 300 mg once daily (n=133) showed significantly greater improvement in depressive symptoms compared with placebo (n=137) from week 1 through to week 8. Mean change in MADRS total score at week 8 was ?17.4 in the quetiapine XR group and ?11.9 in the placebo group (pselleck inhibitor 8 were significantly higher with quetiapine XR compared with placebo. Quetiapine XR improved core symptoms of depression. The study concluded that quetiapine XR (300 mg) once daily monotherapy was significantly more effective than placebo for treating episodes of selleck chemical acute depression in BD, throughout the 8-week study, with significance observed as early as day 7. Adverse events were consistent with the known effects of quetiapine.43) A recently published meta-analysis systematically reviewed the efficacy and tolerability of quetiapine either as monotherapy or adjunctively to mood stabilizers in the treatment of acute bipolar depression. The authors included all randomized, controlled trials (RCTs) comparing quetiapine with other treatments including placebo, in patients with MDEs associated with bipolar I and bipolar II disorders. Published and unpublished RCTs were identified using the Cochrane Central Register of Controlled Trials, MEDLINE, Web of Knowledge, CINHAL, Psyc-INFO, the EU Clinical Trials Register Database, and ClinicalTrials.gov. The primary outcome was the change in scores of depression rating scales. Fifteen hundred and twelve records were identified through database searching out of which 1,017 records were screened after removal of duplicates. Nine hundred and ninety two records were excluded because of methodological reasons and of the remaining 25 studies, full text articles were assessed for eligibility. A further 14 full text records were excluded because these did not entirely fulfill the eligibility criteria for RCTs while meta-analysis was performed on the remaining eleven studies.