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Comparison of the Effects of Quetiapine XR and Lithium Monotherapy on Actigraphy-Measured Circadian Parameters in Patients With Bipolar II Depression

Hwang, Jeong Yeon MD*; Choi, Jae-Won MD, MS; Kang, Seung-Gul MD, PhD; Hwang, Su Hwan PhD§; Kim, Seog Ju MD, PhD; Lee, Yu Jin MD, PhD

Journal of Clinical Psychopharmacology: June 2017 - Volume 37 - Issue 3 - p 351–354
doi: 10.1097/JCP.0000000000000699
Brief Reports

Purpose/Background The aim of this study was to evaluate the effects of quetiapine XR and lithium on actigraphy-measured circadian parameters in patients with bipolar II depression.

Methods/Procedures This was an 8-week, open-label, prospective, randomized comparative study. The assessments included the 17-item Hamilton Depression Rating Scale score and actigraphic measures concerning the previous 7 days, collected at each visit (weeks 0 [baseline], 1, 2, 4, 6, and 8); the actigraphic data were analyzed with a cosinor analysis.

Findings/Results Medication, time, and the interaction between medication and time were significantly associated with acrophase for the entire group (Ps = 0.003, 0.020, and 0.042, respectively). More specifically, acrophase was significantly delayed at weeks 1 and 6 (Ps = 0.004 and 0.039, respectively) in the quetiapine XR group. The F statistics significantly increased over time for the entire group (P < 0.001), and there was a significant increase in F statistics on weeks 4 and 6 in the quetiapine XR group (Ps = 0.016 and 0.020, respectively) and on weeks 4 and 8 in the lithium group (Ps = 0.001 and 0.016, respectively). In addition, scores on the 17-item Hamilton Depression Rating Scale were significantly associated with the F statistics during 8 weeks for the entire group (P = 0.008).

Implications/Conclusions Both quetiapine XR and lithium affected several circadian parameters, including peak activity time and robustness of circadian rhythm, but exerted different effects on acrophase in patients with bipolar II depression. In particular, clinical depressive symptoms were associated with robustness of circadian rhythm during the course of the 8-week treatment.

From the *Seoul National University College of Medicine; and †Department of Psychiatry, Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul; ‡Department of Psychiatry, Gil Medical Center, School of Medicine, Gachon University, Incheon; §Health Service Group, Samsung Electronics, Co, Ltd, Suwon; and ∥Department Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Received December 9, 2016; accepted after revision February 16, 2017.

Reprints: Yu Jin Lee, MD, PhD, Department Psychiatry, Center for Sleep and Chronobiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (e-mail:

S.J.K. and Y.J.L. have contributed equally to this study as corresponding authors.

Presented for partially releasing the preliminary results of this study via a poster presentation at SLEEP 2016, which was the 30th Anniversary Meeting of the Associated Professional Sleep Societies held in Denver, Colorado, from June 11 to 15, 2016.

This study was funded by AstraZeneca (D1443C00031).

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