Influence of single-dose quetiapine on fear network activity - A pharmaco-imaging study

Diemer J, Zwanzger P, Fohrbeck I, Zavorotnyy M, Notzon S, Silling K, Arolt V. Domschke K, Pfleiderer B

Abstract

Anxiety disorders are among the most frequent psychiatric disorders. Current treatment guidelines recommend antidepressants, the calcium modulator gabapentin, and benzodiazepines as pharmacological treatments. However, delayed onset of action precludes the use of antidepressants as an acute treatment, while benzodiazepines can be recommended only as an emergency treatment due to their inherent risk of dependence. Therefore, an alternative pharmacological agent with acute efficacy is needed. Preliminary evidence points towards possible anxiolytic properties of the atypical antipsychotic quetiapine. The goals of this study were to test the acute anxiolytic properties of quetiapine in patients suffering from arachnophobia in a challenge paradigm, and to assess the effects of quetiapine on the central nervous fear network. Our study investigated acute anxiolytic effects of the antipsychotic quetiapine in an fMRI paradigm aimed at provoking acute anxiety by presenting phobic stimuli to patients suffering from arachnophobia. We found quetiapine to significantly reduce somatic anxiety symptoms, but contrary to hypothesis, this effect was not accompanied by a reduction of amygdala reactivity. Thus, the central nervous correlates of the anxiolytic effects of quetiapine remain to be clarified in future studies.