A study showed that adding cognitive behavior therapy (CBT) to quetiapine could reduce suicide risk and improve depressive symptoms in adults with mood disorders.1
“Psychosocially, adding CBT to quetiapine treatment reduces suicide risk for patients with mood disorders due to maladaptive cognitions including hopelessness, helplessness, and intolerance of distress addressed in CBT, such as increased social support, greater hope for the future, or decreased depression severity,” wrote study investigator Ke Wang, from the department of psychiatry at the Affiliated Brain Hospital of Nanjing Medical University, and colleagues.
Research has shown that integrating CBT with pharmacological treatment helps reduce suicide risk in patients with mood disorders. A study published in 2024 revealed that adding CBT to the usual treatment of an inpatient admitted for suicidal ideation or behavior reduced 6-month discharge suicide reattempts and the rate of readmissions.2
In this study, investigators sought to assess the impact of CBT integration with quetiapine, an atypical antipsychotic with anti-anxiety and mood-stabilizing properties, on suicide risk, depressive symptoms, and coping style in adults with mood disorders.1 The primary outcome was suicide risk assessed by the Nurses’ Global Assessment of Suicide Risk (NGASR) scale. Secondary outcomes included depressive symptoms assessed by the 24-item Hamilton Depression Rating Scale (HDRS-24) and coping style assessed by the Simplified Coping Style Questionnaire.
The retrospective study included 137 patients who were admitted to the Affiliated Brain Hospital of Nanjing Medical University for a mood disorder, either depressive disorder or bipolar disorder, from March 2024 to February 2025. The study excluded those with a lifetime diagnosis of any psychotic disorder, suicide risk due to binge substance use or withdrawal, any major medical or neurological illness, > 3 months of lifetime psychotropic medication exposure, active psychotropic medication of ≥ 2 weeks before enrollment, and pregnancy or lactation.
Participants were randomized 1:1 to receive either quetiapine plus CBT (n = 69) or quetiapine alone (n = 70). At baseline, the groups did not show a significant difference in the high suicide risk.
All participants received an oral administration of quetiapine for 12 weeks, starting with 100 mg/d on day 1 and increased by 100 mg/d on the following 4 days. At the psychiatrist’s discretion, the dose could be augmented to 800 mg/d on day 6; the augmented dose could not exceed 200 mg/d.
Participants in the quetiapine arm still received treatment as usual consisting of psychoeducation and self-management (i.e., encouragement of a healthy lifestyle with a regular diet and sleep time, and appropriate exercise). The quetiapine plus CBT arm also received treatment as usual; these patients received 50-minute sessions of CBT weekly over 12 weeks, which included 7 core modules: psychoeducation, emotional recognition, behavioral activation, the ABC model and chain analysis, identifying automatic thoughts, thought challenging and substituting, improving social skills, and relapse prevention.
High suicide risk decreased by 32.9% after the 12-week intervention in the quetiapine plus CBT arm, versus 15.7% in the quetiapine only arm. The quetiapine plus CBT arm had a significantly lower suicide risk at 12 weeks than the quetiapine arm (30% vs 13.40%; P =.02).1
The analysis of covariance (ANCOVA) demonstrated a significant main effect of treatment in scores of NGASR (P <.01), HDRS-24 (P <.01), positive coping (P <.01), and negative coping (P <.01) of the Simplified Coping Style Questionnaire (SCSQ). Compared with the quetiapine only, the quetiapine plus CBT group had lower NGASR (mean difference, -1.7; 95% confidence interval [CI], -2.3 to -1.0) and HDRS-24 scores (mean difference, -6.5; 95% CI, -9.0 to -4.0), greater positive coping (mean difference, 2.4; 95% CI, 0.9 to 3.9), and lower negative coping (-2.3; 95% CI, -3.2 to -1.4) after 12 weeks.1
“In conclusion, our findings suggest adding CBT to quetiapine to decrease suicide risk for adult patients with mood disorders, reduce depressive symptoms, promote their positive coping style, and decrease negative coping style,” investigators wrote. “Therefore, clinical benefits from CBT combined with quetiapine suggests patients with mood disorder and suicide risk receiving pharmacotherapy should also be offered skills-based psychosocial interventions that emphasize illness management strategies and enhance coping skills. Health care systems should recruit more trained psychologists and offer combinations of evidence-based pharmacotherapy and psychotherapy to patients with mood disorder, especially with suicide risk in resource-limited settings.”1
References
Wang K, Cai S, Duanmu XR, et al. Effect of adding cognitive behavioral therapy to quetiapine on suicide risk, depressive symptoms, and coping style in adult patients with mood disorders. J Psychiatr Res. Published online January 3, 2026. doi:10.1016/j.jpsychires.2026.01.005
Derman C. Adding Brief CBT to Inpatient’s Usual Treatment Reduces Suicide Reattempts. HCPLive. Published on September 18, 2024. Accessed on January 16, 2026. https://www.hcplive.com/view/adding-brief-cbt-to-inpatient-s-usual-treatment-reduces-suicide-reattempts