Quetiapine

證據等級: L5

預測適應症: 10 個

Quetiapine: From Psychiatric Disorders to Trichotillomania

One-Sentence Summary

Quetiapine is an atypical antipsychotic generally used for schizophrenia, bipolar disorder, and as adjunctive therapy in major depressive disorder (general clinical knowledge; no Taiwan/NZ regulatory indication text is on file for this drug). Among 10 TxGNN-predicted indications, Trichotillomania (hair-pulling disorder) is the only candidate with a genuine mechanistic rationale and drug-specific human data — supported by 7 publications including case reports of quetiapine treating trichotillomania, though no clinical trials have been registered. The other 9 predicted indications (mostly ultra-rare genetic/ophthalmologic syndromes) lack any supporting evidence and are not clinically plausible for this drug class; they are not pursued further in this report.

Quick Overview

Item	Content
Original Indication	Not available on file (see note below)
Predicted New Indication	Trichotillomania
TxGNN Prediction Score	99.38%
Evidence Level	L4
New Zealand Market Status	✗ Not Marketed
Number of Authorizations	0
Recommended Decision	Hold

Note on Original Indication: No Taiwan/NZ license or indication text exists in the regulatory data provided (market_status: 未上市, 0 licenses). The original-indication context above (schizophrenia/bipolar disorder) reflects general public drug knowledge, not data extracted from this evidence pack, and should be confirmed against a formal source before use in any regulatory submission.

Why is This Prediction Reasonable?

Detailed mechanism-of-action data is not available in this evidence pack (original_moa: [Data Gap]). Based on generally known pharmacology, quetiapine is a D2/5-HT2A receptor antagonist. Low-dose atypical antipsychotics with this receptor profile are sometimes used adjunctively in obsessive-compulsive-spectrum and impulse-control disorders.

Trichotillomania is classified as an OCD-spectrum, body-focused repetitive behavior. The serotonin-dopamine modulation hypothesis provides a plausible mechanistic bridge between quetiapine's known pharmacology and this indication, which is consistent with why TxGNN surfaced the link.

Importantly, the literature is mixed, not uniformly supportive: alongside case reports of quetiapine improving trichotillomania, there is also a published case of quetiapine inducing/exacerbating obsessive-compulsive symptoms — including trichotillomania — in a patient with pre-existing OCD (PMID 11212595). This bidirectional signal is a real pharmacological consideration, not just a data gap, and should be treated as part of the evidence base rather than omitted.

For context, the top-ranked TxGNN prediction overall (retinal dystrophy with extraocular anomalies, score 99.57%) was reviewed against 15 retrieved publications, none of which mention quetiapine — this is assessed as embedding co-occurrence noise rather than real drug-disease evidence, and is not pursued. The remaining 8 of 10 predicted indications (ultra-rare genetic/dysmorphic syndromes) returned zero clinical trials and zero literature and are held for the same reason.

Clinical Trial Evidence

Currently no related clinical trials registered.

Literature Evidence

PMID	Year	Type	Journal	Key Findings
12405081	2002	Review/Case series	Psychiatry	Overview of trichotillomania pharmacotherapy; case report of a 33-year-old female with favorable clinical response to quetiapine
19142421	2008	Case report	Revista Brasileira de Psiquiatria	"Quetiapine for the treatment of trichotillomania" (abstract not available)
11212595	2001	Case report/Review	Journal of Psychiatry & Neuroscience	Reports quetiapine exacerbating obsessive-compulsive symptoms, including trichotillomania, in a patient with pre-existing OCD/bipolar disorder — a cautionary counter-signal
38797877	2025	Review	International Journal of Dermatology	Notes lack of consensus treatment guidelines for trichotillomania; calls for better clinician education on pharmacological options
17484394	2006	Review	The Journal of Practical Nursing	General treatment overview of trichotillomania (abstract not available)
27840761	2016	Case report	Case Reports in Psychiatry	Trichotillomania as a manifestation of dementia; not quetiapine-specific
20833945	2010	Case report	Psychosomatics	Recurrent Rapunzel syndrome and trichotillomania; not quetiapine-specific

New Zealand Market Information

Quetiapine is currently not marketed in New Zealand under this evidence pack's regulatory data source, with 0 authorizations on file. No product license records are available to summarize.

Safety Considerations

Please refer to the package insert for safety information. (Key warnings, contraindications, and drug-interaction data are all marked as data gaps in this evidence pack; TFDA package insert warnings/contraindications are flagged as a Blocking data gap — DG001 — that must be resolved before a formal safety assessment can proceed.)

One literature-derived caution worth carrying forward: PMID 11212595 documents a case of quetiapine-induced/exacerbated obsessive-compulsive symptoms (including trichotillomania) — the drug's effect on this symptom cluster may not be uniformly positive.

Conclusion and Next Steps

Decision: Hold

Rationale: Evidence for trichotillomania consists only of small case reports/series and reviews (L4, no RCTs), with one report describing a paradoxical worsening effect — the signal is mechanistically plausible but not yet actionable for a repurposing decision. The other 9 TxGNN-predicted indications lack any supporting evidence and are not viable candidates.

To proceed, the following is needed:

TFDA/regulatory package insert warnings and contraindications (Blocking gap, DG001)
Confirmed original indication and MOA data from DrugBank or an authoritative label (DG002)
A prospective or controlled study (even small open-label) specifically evaluating quetiapine in trichotillomania, given the mixed case-report signal
Formal DDI dataset (current query returned not_found)
Clarification of NZ/Taiwan market and licensing status, since no product is currently on file
Disclaimer

This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.