The single most important research study in the past year in the area of clinical therapeutics of bipolar disorder was conducted by Geddes and colleagues at Oxford University in England[1]. Using a randomized open-label design (no placebo control group and subjects knew which medications they were receiving), the BALANCE study sorted 330 subjects with bipolar disorder type I into three treatment groups: lithium alone, valproate (Depakote) alone, or combination treatment with both lithium and valproate. The outcome measures were time to recurrence of a major mood episode, either mania or depression. The study design allowed for an extended, two year follow-up on these subjects. This time frame allows for meaningful assessment of genuine prophylactic effects. The results found that combination therapy was most effective, marginally more so that lithium alone, but significantly greater than valproate monotherapy. The interpretation of the data supports the unique efficacy of lithium as the single-most effective mood stabilizer available.
Continue reading » “New Wonder Drug Remarkably Effective in Bipolar Disorder: Lithium (Yes, Lithium).”Blog
Acute Antidepressant Effects of Lamotrigine: More and More Disappointing.
In the past several years, two new studies have been published examining the efficacy (in pristine, experimental conditions; rigorous selection criteria, minimal comorbid conditions) and effectiveness (real world variability) of lamotrigine (Lamictal) in the treatment of acute bipolar depression [1, 2]. These and other studies were recently summarized in a review paper by Amann and colleagues in the Journal of Psychopharmacology[3]. Attempting to synthesize disparate findings, Amann concludes that “…the antidepressant effect of LTG in acute bipolar depression, if it exists, is small.”
Continue reading » “Acute Antidepressant Effects of Lamotrigine: More and More Disappointing.”Not the SAMe Old Story: New Antidepressant Data on Popular Nutritional Supplement.
Evidence is building for the use of SAMe (S-adenosyl methionine) as adjunctive therapy in major depressive disorder. Just this past August, a landmark study by Papakostas, et al, demonstrated the superior efficacy of SAMe when combined with other antidepressant agents (e.g., fluoxetine, venlafaxine, duloxetine) over antidepressant monotherapy.1 Although SAMe has been reported to induce mania in some case reports, there may be a potential role in treatment for bipolar depression as well.2
Continue reading » “Not the SAMe Old Story: New Antidepressant Data on Popular Nutritional Supplement.”Riluzole: Promising Therapy for Treatment-Resistant Mood Disorders.
One 8-week study showed possible response based on significant improvement in Montgomery-Asberg Depression Rating Scale scores in patients treated for acute bipolar depression when riluzole was added to other antidepressants.1 However, the small, non-randomized, non-blinded nature of the trial limits the conclusions that can be drawn. Of note, there were no instances of mania or hypomania in this trial, indicating that riluzole may not have the mood destabilizing effects of many other antidepressants. Trials with larger sample sizes would be necessary to confirm this result.
Continue reading » “Riluzole: Promising Therapy for Treatment-Resistant Mood Disorders.”N-Acetyl Cysteine for Bipolar Depression: Novel Approach, Limited Data.
Always looking for novel ways to treat bipolar disorder, researchers have turned to an old standby for Tylenol overdose: n-acetyl cysteine (NAC). Among other causes, mood disorders may be a result of oxidative or metabolic imbalances in the brain caused by low levels of the biochemical glutathoine. NAC works to restore these imbalances, which are possibly at the root bipolar depression, by working as an antioxidant.
Continue reading » “N-Acetyl Cysteine for Bipolar Depression: Novel Approach, Limited Data.”Chronotherapeutics for Affective Disorders. A Clinician’s Manual for Light and Wake Therapy. Wirz-Justice A, Benedetti F, and Terman M. Karger, 2009
When it comes to mood disorders, American psychiatry, by and large, lacks rhythm. That is, it lacks an interest in research on circadian rhythms, the relevance of circadian neurobiology for understanding the pathophysiology of affective disorders, and in the application of such studies to generating new treatment techniques. Several European countries, in contrast, appear to feel this groove and have generated decades of clinical research in this area. So what gives?
Continue reading » “Chronotherapeutics for Affective Disorders. A Clinician’s Manual for Light and Wake Therapy. Wirz-Justice A, Benedetti F, and Terman M. Karger, 2009”Bipolar II Disorder. Modelling, Measuring and Managing. Gordon Parker. Cambridge University Press. 2008
Finally, a book devoted to the other bipolar disorder. Bravo! Gordon Parker, the Australian psychiatrist, researcher and head of the venerable Black Dog Institute in Sydney, deserves credit on this basis alone. But this is far from the only virtue of this monograph. Here we get a rich, quirky wonderful assemblage of opinion from the leading authorities on this prevalent and understudied form of manic depression. The combination of being the first publication out of the gate on this important area together with its quality, diversity and depth make this required reading for all clinicians and those patients and significant others thirsty for knowledge of this bipolar subtype. For this group, here’s the bottom line: Read this book!
Continue reading » “Bipolar II Disorder. Modelling, Measuring and Managing. Gordon Parker. Cambridge University Press. 2008”Bipolar Depression. A Comprehensive Guide. El-Mallakh RS & Ghaemi SN. American Psychiatric Publishing, 2006.
One sentence opinion: A necessary but typically uninspiring review of an important subject.
Is there a need to devote a book specifically to the depressed phase of bipolar disorder? Absolutely. Should it present data from each of the important research areas on this subject? Of course. Does it need to do so in a formulaic and bland fashion? Judging from the products of the major psychiatric publishers, the unfortunate answer appears to be yes. With a few rare exceptions, such as the stellar Manic Depressive Illness by Goodwin and Jamison or A Mood Apart by Peter Whybrow, review books on psychiatric topics are all too often poorly written, uncreative amalgams of multi-authored chapters without a coherent editorial voice or viewpoint. The result is reading that becomes as dutiful as the writing.
Continue reading » “Bipolar Depression. A Comprehensive Guide. El-Mallakh RS & Ghaemi SN. American Psychiatric Publishing, 2006.”Treating Bipolar Disorder. Ellen Frank, Ph.D., Guilford Press, 2005
Though almost 5 years old, Treating Bipolar Disorder, by Ellen Frank is still one of the first and most frequent reading recommendations that I make for newly diagnosed patients. Written in plain, easy to understand English, this little gem asserts that affective relapse in bipolar disorder follows from disruptions in social and circadian rhythms. This theory led to the development of a disorder-specific therapy, Interpersonal Social Rhythm Therapy (IPSRT) whose case-based description is the mainstay of this book.
Continue reading » “Treating Bipolar Disorder. Ellen Frank, Ph.D., Guilford Press, 2005”Do Antiepileptics Increase the Risk of Suicide?
Antiepileptic medications have been a mainstay in the treatment of bipolar illness since the use of valproate in the 1980’s.Since that time other anticonvulsants such as carbamazepine, lamotrigine, and oxcarbazepine have been added to the list that help control the mood fluctuations that occur in bipolar disorder. In January 2008, the FDA issued an alert about patients being treated with antiepileptics:
Continue reading » “Do Antiepileptics Increase the Risk of Suicide?”