Treatment of agitation and aggression in bipolar mania: Efficacy of quetiapine

Peter F. Buckley, Björn Paulsson, Martin Brecher

Research output: Contribution to journalArticle

17 Scopus citations


Objective: Agitation and aggression are potentially disruptive and dangerous features of bipolar mania. This analysis evaluated the effects of quetiapine on agitation and aggression in patients with bipolar I mania. Methods: Four double-blind, randomized, controlled trials were conducted using similar protocols; 407 patients with bipolar I mania were randomized to quetiapine monotherapy (200-800 mg/day) or placebo for 12 weeks, and 402 patients were randomized to quetiapine (200-800 mg/day) or placebo in combination with lithium (Li) or divalproex (DVP) for 3 or 6 weeks. Measurements of agitation included the Positive and Negative Syndrome Scale (PANSS) Activation subscale, PANSS Supplemental Aggression Risk subscale scores, and Young Mania Rating Scale (YMRS) items relevant to agitation. Results: Initial reductions in both the PANSS Activation and PANSS Supplemental Aggression Risk subscale scores were noted by Day 4 with quetiapine and placebo. The reduction in PANSS Activation subscale scores was significantly greater with quetiapine monotherapy than placebo first at Day 21 (- 3.5 versus - 1.4, P < 0.001) and also at Day 84 (- 4.8 versus - 1.2, P < 0.001). The improvement in PANSS Supplemental Aggression Risk subscale score was significantly greater with quetiapine monotherapy than placebo by Day 14 (P < 0.01) and all time points thereafter including Day 21 (- 4.0 versus - 1.8, P < 0.001) and Day 84 (- 5.6 versus - 1.7, P < 0.001). In combination therapy, the mean improvement in PANSS Activation subscale score at Day 21 was numerically but not significantly different with QTP +Li/DVP than PBO + Li/DVP (- 4.2 versus - 3.2, P = 0.087). The mean PANSS Supplemental Aggression Risk subscale scores were significantly improved at Day 21 with QTP + Li/DVP versus PBO + Li/DVP (- 5.05 versus - 3.69, P < 0.05). Conclusions: Quetiapine is an effective and appropriate treatment choice in managing agitation and aggression associated with bipolar mania.

Original languageEnglish (US)
Pages (from-to)S33-S43
JournalJournal of Affective Disorders
Issue numberSUPPL. 1
StatePublished - May 31 2007



  • Aggression
  • Agitation
  • Bipolar disorder
  • Quetiapine

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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