Lorazepam-Quetiapine Doses in Manic and Mixed Episodes

Objective: Little is known about lorazepam-quetiapine combination doses requirements for mania and mixed bipolar episodes despite frequent use. It was previously assumed that, by adding a benzodiazepine, antipsychotic dose could be lowered. The aim of the current study was to test this assumption and to evaluate dosage of lorazepam and quetiapine, when used together under routine clinical conditions for the treatment of manic or mixed episodes. Methods: Charts of all bipolar and schizoaffective adult inpatients, who had received quetiapine and lorazepam for a manic or mixed episode between 1999 and 2005 were retrospectively reviewed. Results: Seventy eight charts were analyzed. A positive linear relation was found between lorazepam dosage and respectively manic symptoms severity at entry and maximum quetiapine dosage. High quetiapine dosage during hospitalization predicts high quetiapine dosage at discharge whereas high lorazepam dosage does not. Conclusions: The present study confirms that, in natural settings, benzodiazepines were used frequently in association to quetiapine during the treatment of manic or mixed states. Lorazepam augmentation of quetiapine treatment does not lead to a reduction of the antipsychotic dose. Lorazepam dosage may rather be determined by the need of sedation, which declines at discharge (German J Psychiatry 2008; 11: 107-110).