skip to main content

Quetiapine Across Bipolar Phases — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

ModerateMood DisordersQuetiapine Across Bipolar PhasesMRCPsych Paper B

A 42-year-old woman with bipolar I disorder has responded to quetiapine 600 mg daily for a manic episode. While continuing treatment, she subsequently develops a moderate bipolar depressive episode, which has only just been recognised and whose response to treatment has not yet been assessed. Adherence is confirmed, she has no severe adverse effects, and there is no immediate risk requiring urgent intervention. Which is the most appropriate statement about quetiapine at this stage?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Continue quetiapine while reviewing its dose, response and tolerability

Quetiapine can be continued because it is an established treatment for both acute mania and bipolar depression; a change in episode polarity is not, by itself, an indication for abrupt discontinuation. However, treatment must be reviewed rather than automatically maintaining 600 mg: the UK SmPC recommends 300 mg daily for bipolar depression and reports no additional average benefit at 600 mg, although some individuals may benefit. Abrupt cessation is inappropriate and can cause withdrawal symptoms. Lithium is important for long-term relapse prevention but is not an obligatory immediate replacement for quetiapine. SSRI monotherapy is inappropriate in bipolar I disorder because of the risk of mood destabilisation. Lamotrigine may be considered in bipolar depression, but it need not be added automatically or accompanied by immediate quetiapine withdrawal.

Reference: NICE. Bipolar disorder: assessment and management (CG185), recommendations 1.5.3, 1.5.14–1.5.15, 1.6.3 and 1.7.5. Updated 2025. https://www.nice.org.uk/guidance/cg185/chapter/Recommendations