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East Midlands & South Yorkshire
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Studies A-Z > C > Cequel
Comparative Evaluation of QUEtiapine-Lamotrigine combination versus quetiapine monotherapy (and folic acid versus placebo) in people with bipolar depression
Research summary
Background: Much of the burden of bipolar disorder is caused by depressive symptoms. Bipolar depression is often treated in the same way as major depressive disorder, but there is little evidence that this is effective, and concern that some treatments will increase the risk of switch to a manic state.
CEQUEL is designed to address the urgent need to identify effective treatments that:
- Provide safe, tolerable and rapid reduction of depressive symptoms
- Avoid induction of manic symptoms in the short term
- Maintain continued remission from depressive symptoms and freedom from manic symptoms in the longer term.
Interventions: The NICE guidelines on treatment of bipolar disorder include quetiapine, an atypical antipsychotic, as a first-line treatment for depression. Evidence from RCTs suggests that quetiapine provides rapid relief of acute depression but has a high incidence of sedation and study withdrawal, indicating the need for alternative treatments.
There is also evidence that lamotrigine, an anticonvulsant, is tolerable and may be moderately effective for bipolar depression, but the need for slow titration can lead to delayed therapeutic response. CEQUEL will explore the possibility that the combination of quetiapine and lamotrigine will be more effective than quetiapine alone both for acute treatment of depressive symptoms and for longer-term maintenance of remission and prevention of depressive or manic relapse. There is also evidence that folic acid, vitamin B9, can increase response to antidepressant treatments. CEQUEL will compare folic with placebo as adjunctive therapy and explore these subgroup effects.