Neurochemical effects of quetiapine in patients with bipolar mania: A proton magnetic resonance spectroscopy study

Caleb M. Adler*, Melissa P. Delbello, Wade A. Weber, Kelly B. Jarvis, Jeffrey Welge, Wen Jang Chu, Emily Rummelhoff, Mi Jung Kim, Jing Huei Lee, Stephen M. Strakowski

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Although the neurophysiology underlying pharmacotherapy for bipolar disorder remains poorly understood, recent studies suggest that therapeutic mechanisms may be reflected in changes in concentrations of N-acetylaspartate (NAA), a putative measure of neuronal integrity and metabolism. In this study, we used magnetic resonance spectroscopy (MRS) to examine prefrontal NAA in patients receiving quetiapine for bipolar mania. On the basis of previous findings, we hypothesized that remission would be associated with increased NAA concentrations in the prefrontal cortex.Thirty-one manic bipolar patients and 13 healthy subjects were recruited to participate in this prospective study. All subjects participated in MRS at baseline and after 8 weeks of treatment. Bipolar subjects received open-label quetiapine monotherapy (mean dose [SD], 584 [191] mg). Fourteen patients remitted (Young Mania Rating Scale ≤ 12) ("remitters"), 11 patients did not ("nonremitters"), and 6 patients were lost to follow-up.Bipolar and healthy subjects did not significantly differ in baseline NAA or degree of change during the 8 weeks. Remitters showed greater mean baseline NAA concentrations in the right ventrolateral prefrontal cortex compared with nonremitters (P < 0.05). In the anterior cingulate, remitters showed near significantly decreased baseline NAA concentrations at baseline (P < 0.06), and significant differences in NAA change during the 8 weeks of treatment (P < 0.03). Manic patients who remitted with quetiapine treatment in the course of this study exhibited distinct patterns of baseline prefrontal NAA concentration, coupled with decreased NAA in the anterior cingulate with treatment; the latter possibly reflecting disparate effects of quetiapine on neuronal metabolism. These data support suggestions that therapeutic effects of quetiapine involve metabolic effects on specific prefrontal regions.

Original languageEnglish (US)
Pages (from-to)528-532
Number of pages5
JournalJournal of clinical psychopharmacology
Issue number4
StatePublished - Aug 2013


  • bipolar disorder
  • MRS
  • quetiapine

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)


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