Rapid titration versus conventional titration of quetiapine in the treatment of bipolar mania: A preliminary trial

The present trial was designed as a pilot study to re-examine how fast the dose of quetiapine in combination with mood stabilizers can be titrated upward in acutely ill patients with bipolar mania. Patients were assigned to either a rapid titration group (RTG) or a conventional titration group (CTG). Quetiapine was administered twice daily in a 3-day period in the RTG (200 mg/day on day 1; 400 mg/day on day 2; and 600 mg/day on day 3) and in a 5-day period in the CTG (50 mg/day on day 1; 100 mg/day on day 2; 200 mg/day on day 3; 300 mg/day on day 4; and 400 mg/day on day 5). The Young Mania Rating Scale (YMRS) and Clinical Global Impression-Severity (CGI-S) scores were assessed at days 1 (baseline), 3, 5, 7, 14 and 21. The Barnes Akathisia Rating Scale and Simpson-Angus Rating Scale (SARS) were assessed at days 1, 2, 3, 4, 5, 6, 7, 14 and 21. RTG and CTG showed significant improvement on the scores of YMRS and CGI-S during the study without group differences. Both treatments were well tolerated without clinically significant differences in tolerability measures. Treatment was not limited by adverse events in the two groups. This study demonstrates the potential benefit and tolerability of rapid titration of quetiapine in the treatment of acutely ill bipolar disorder. This preliminary study proposes that rapid titration of quetipaine in combination with a mood stabilizer for the treatment of bipolar mania is effective and tolerable in comparison with conventional titration. A controlled study with a larger cohort should be performed.