This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.The newest class of antidepressants, the selective serotonin reuptake inhibitors (SSRIs), are the most widely prescribed class of psychiatric medications and are among the most widely prescribed pharmaceuticals overall. Although these currently available antidepressants are safe and effective, there are still a number of limitations. First, the medications take several weeks to work. Although there is an increase of serotonin in the synapse shortly after drug administration, all available receptors are flooded. Full antidepressant effect, therefore, most likely occurs as a result of neuronal changes that may take at least two weeks, or up to six weeks. Second, patients with insomnia often require additional hypnotic medications, most often benzodiazepines. The high potential for abuse and tolerance make these drugs less than ideal. Newer hypnotics are indicated only for short-term treatment of insomnia. Third, many patients with depression suffer from concomitant high levels of anxiety and agitation. In some cases, these symptoms are made even worse in the initial days of taking SSRIs. Finally, the response to antidepressant medications is often incomplete, with many patients still experiencing residual depressive symptoms that have been shown to lead to high risk of relapse.Many attempts have been made to overcome these problems, but we believe that Seroquel (Quetiapine) co-administration could be ideal. In our own experience treating patients with major depressive episodes, we have found that co-prescribing quetiapine with an SSRI antidepressant often leads to rapid resolution of insomnia and anxiety, blocks activating effects of the SSRI, speeds the onset of the antidepressant effect, and improves the overall quality of the antidepressant response. Furthermore, quetiapine is extremely well tolerated in this group of patients.We believe that the use of adjunctive quetiapine in the treatment of patients suffering from major depressive episode will be a significant advance in terms of speeding onset of antidepressant action and improving the overall quality of response. Currently, more than two-thirds of patients with depression treated in psychiatric clinics receive at least one other medication, very frequently an anxiolytic or hypnotic. Quetiapine would, in our opinion, be a better option for many of these patients than currently used agents.

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National Center for Research Resources (NCRR)
General Clinical Research Centers Program (M01)
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Mount Sinai School of Medicine
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New York
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