Advertisement

Pharmacological treatment of acute bipolar depression

  • Gary S. Sachs
  • Louisa G. Sylvia
  • Hannah G. Lund
Part of the Milestones in Drug Therapy book series (MDT)

Abstract

Acute depression is the condition for which bipolar patients most often seek treatment. The foundation of evidence-based practice is the practitioner’s obligation to inform the patient of proven therapies that may exist to treat their condition. The best guidance for meeting this obligation in clinical practice comes from double-blind, placebo-controlled trials with adequate sample size, referred to in this chapter as Category A evidence. This level of evidence is currently available for only four pharmacological treatments, lamotrigine, olanzapine plus fluoxetine, olanzapine monotherapy, and quetiapine. Interestingly, the most common treatment for bipolar depression — the adjunctive use of standard antidepressants along with lithium or valproate — has not been shown to be effective in any Category A study. Additional treatments for bipolar depression are needed for the many depressed bipolar patients who do not respond adequately to currently available treatments. Several classes of medications show promise for these patients. Exploring the variety of mechanisms by which these medications work may shed light on the pathophysiology of bipolar disorder.

Keywords

Bipolar Disorder Mood Stabilizer Bipolar Patient Bipolar Depression Olanzapine Monotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Klerman GL (1990) The psychiatric patient’s right to effective treatment: implications of Osheroff v. Chestnut Lodge. Am J Psychiatry 147: 409–418PubMedGoogle Scholar
  2. 2.
    Judd LL, Schettler PJ, Akiskal HS, Maser J, Coryell W, Solomon D, Endicott J, Keller M (2003) Long-term symptomatic status of bipolar I versus bipolar II disorders. Int J Neuropsychopharmacol 6: 127–137PubMedCrossRefGoogle Scholar
  3. 3.
    Sachs GS (2007) Bipolar disorder clinical synthesis: where does the evidence lead? Focus V: 1–11Google Scholar
  4. 4.
    Johnson SL, Brickman AL (2006) Diagnostic inconsistency: a marker of service utilization in bipolar disorder. Manag Care Interface 19: 41–45PubMedGoogle Scholar
  5. 5.
    Keller MB, Hanks DL, Klein DN (1996) Summary of the DSM-IV mood disorders field trial and issue overview. Psychiatr Clin North Am 19: 1–28PubMedCrossRefGoogle Scholar
  6. 6.
    Bowden CL (2001) Strategies to reduce misdiagnosis of bipolar depression. Psychiatr Serv 52: 51–55PubMedCrossRefGoogle Scholar
  7. 7.
    Revicki DA, Hanlon J, Martin S, Gyulai L, Nassir Ghaemi S, Lynch F, Mannix S, Kleinman L (2005) Patient-based utilities for bipolar disorder-related health states. J Affect Disord 87: 203–210PubMedCrossRefGoogle Scholar
  8. 8.
    Rush AJ, Kraemer HC, Sackeim HA, Fava M, Trivedi MH, Frank E, Ninan PT, Thase ME, Gelenberg AJ, Kupfer DJ et al (2006) Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology 31: 1841–1853PubMedCrossRefGoogle Scholar
  9. 9.
    Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R et al (2003) The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry 54: 573–583PubMedCrossRefGoogle Scholar
  10. 10.
    Calabrese JR, Bowden CL, Sachs GS, Ascher JA, Monaghan E, Rudd GD (1999) A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group. J Clin Psychiatry 60: 79–88PubMedGoogle Scholar
  11. 11.
    Calabrese J, Huffman RF, White R, Edwards S, Thompson T, Ascher J, Monaghan E, Leadbetter R (2008) Lamotrigine in the acute treatment of bipolar depression: results of five double-blind, placebo-controlled clinical trials. Bipolar Disord 10: 323–333PubMedCrossRefGoogle Scholar
  12. 12.
    Nierenberg AA, Ostacher MJ, Calabrese JR, Ketter TA, Marangell LB, Miklowitz DJ, Miyahara S, Bauer MS, Thase ME, Wisniewski SR et al (2006) Treatment-resistant bipolar depression: a STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotrigine, inositol, or risperidone. Am J Psychiatry 163: 210–216PubMedCrossRefGoogle Scholar
  13. 13.
    van der Loos ML, Kolling P, Knoppert-van der Klein EA, Nolen W (2007) Lamotrigine in the treatment of bipolar disorder. A review. Tijdschr Psychiatr 49: 95–103PubMedGoogle Scholar
  14. 14.
    Brown EB, McElroy SL, Keck PE, Jr, Deldar A, Adams DH, Tohen M, Williamson DJ (2006) A 7-week, randomized, double-blind trial of olanzapine/fluoxetine combination versus lamotrigine in the treatment of bipolar I depression. J Clin Psychiatry 67: 1025–1033PubMedCrossRefGoogle Scholar
  15. 15.
    Tohen M, Vieta E, Calabrese J, Ketter TA, Sachs G, Bowden C, Mitchell PB, Centorrino F, Risser R, Baker RW et al (2003) Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry 60: 1079–1088PubMedCrossRefGoogle Scholar
  16. 16.
    Calabrese JR, Keck PE Jr, Macfadden W, Minkwitz M, Ketter TA,Weisler RH, Cutler AJ, McCoy R, Wilson E, Mullen J (2005) A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry 162: 1351–1360PubMedCrossRefGoogle Scholar
  17. 17.
    Thase ME, Macfadden W, Weisler RH, Chang W, Paulsson B, Khan A, Calabrese JR (2006) Efficacy of quetiapine monotherapy in bipolar I and II depression: a double-blind, placebo-controlled study (the BOLDER II study). J Clin Psychopharmacol 26: 600–609PubMedCrossRefGoogle Scholar
  18. 18.
    Nemeroff CB, Evans DL, Gyulai L, Sachs GS, Bowden CL, Gergel IP, Oakes R, Pitts CD (2001) Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry 158: 906–912PubMedGoogle Scholar
  19. 19.
    Sachs GS, Nierenberg AA, Calabrese JR, Marangell LB,Wisniewski SR, Gyulai L, Friedman ES, Bowden CL, Fossey MD, Ostacher MJ et al (2007) Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 356: 1711–1722PubMedCrossRefGoogle Scholar
  20. 20.
    Leverich GS, Altshuler LL, Frye MA, Suppes T, McElroy SL, Keck PE Jr, Kupka RW, Denicoff KD, Nolen WA, Grunze H et al (2006) Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. Am J Psychiatry 163: 232–239PubMedCrossRefGoogle Scholar
  21. 21.
    Post RM, Altshuler LL, Leverich GS, Frye MA, Nolen WA, Kupka RW, Suppes T, McElroy S, Keck PE, Denicoff KD et al (2006) Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry 189: 124–131PubMedCrossRefGoogle Scholar
  22. 22.
    Vieta E, Martinez-Aran A, Goikolea JM, Torrent C, Colom F, Benabarre A, Reinares M (2002) A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry 63: 508–512PubMedGoogle Scholar
  23. 23.
    Silverstone T (2001) Moclobemide versus imipramine in bipolar depression: a multicentre double-blind clinical trial. Acta Psychiatr Scand 104: 104–109PubMedCrossRefGoogle Scholar
  24. 24.
    Amsterdam JD, Shults J, Brunswick DJ, Hundert M (2004) Short-term fluoxetine monotherapy for bipolar type II or bipolar NOS major depression — low manic switch rate. Bipolar Disord 6: 75–81PubMedCrossRefGoogle Scholar
  25. 25.
    Amsterdam JD, Garcia-Espana F, Fawcett J, Quitkin FM, Reimherr FW, Rosenbaum JF, Schweizer E, Beasley C (1998) Efficacy and safety of fluoxetine in treating bipolar II major depressive episode. J Clin Psychopharmacol 18: 435–440PubMedCrossRefGoogle Scholar
  26. 26.
    Himmelhoch JM, Thase ME, Mallinger AG, Houck P (1991) Tranylcypromine versus imipramine in anergic bipolar depression. Am J Psychiatry 148: 910–916PubMedGoogle Scholar
  27. 27.
    Nolen WA, Kupka RW, Hellemann G, Frye MA, Altshuler LL, Leverich GS, Suppes T, Keck PE Jr, McElroy S, Grunze H et al (2007) Tranylcypromine versus lamotrigine in the treatment of refractory bipolar depression: a failed but clinically useful study. Acta Psychiatr Scand 115: 360–365PubMedCrossRefGoogle Scholar
  28. 28.
    Sachs GS, Lafer B, Stoll AL, Banov M, Thibault AB, Tohen M, Rosenbaum JF (1994) A doubleblind trial of bupropion versus desipramine for bipolar depression. J Clin Psychiatry 55: 391–393PubMedGoogle Scholar
  29. 29.
    Altshuler L, Suppes T, Black D, Nolen WA, Keck PE Jr, Frye MA, McElroy S, Kupka R, Grunze H, Walden J et al (2003) Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. Am J Psychiatry 160: 1252–1262PubMedCrossRefGoogle Scholar
  30. 30.
    Joffe RT, MacQueen GM, Marriott M, Trevor Young L (2004) A prospective, longitudinal study of percentage of time spent ill in patients with bipolar I or bipolar II disorders. Bipolar Disord 6: 62–66PubMedCrossRefGoogle Scholar
  31. 31.
    Goldberg JF, Perlis RH, Ghaemi SN, Calabrese JR, Bowden CL, Wisniewski S, Miklowitz DJ, Sachs GS, Thase ME (2007) Adjunctive antidepressant use and symptomatic recovery among bipolar depressed patients with concomitant manic symptoms: findings from the STEP-BD. Am J Psychiatry 164: 1348–1355PubMedCrossRefGoogle Scholar
  32. 32.
    Gijsman HJ, Geddes JR, Rendell JM, Nolen WA, Goodwin GM (2004) Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry 161: 1537–1547PubMedCrossRefGoogle Scholar
  33. 33.
    Davis LL, Bartolucci A, Petty F (2005) Divalproex in the treatment of bipolar depression: a placebo-controlled study. J Affect Disord 85: 259–266PubMedCrossRefGoogle Scholar
  34. 34.
    Sachs G, Altshuler L, Ketter T, Suppes T, Rasgon N, Frey M, Collins M (2001) Divalproex versus placebo for treatment of Bipolar depression. 40th American College of Neuropsychopharmacology (ACNP), Waikoloa, Hawaii; December 9–13, 2001Google Scholar
  35. 35.
    Ghaemi SN, Gilmer WS, Goldberg JF, Zablotsky B, Kemp DE, Kelley ME, Bauer AD, Fleck J, Filkowski MM, Stan VA et al (2007) Divalproex in the treatment of acute bipolar depression: a preliminary double-blind, randomized, placebo-controlled pilot study. J Clin Psychiatry 68: 1840–1844PubMedCrossRefGoogle Scholar
  36. 36.
    Lambert PA, Carraz G, Borselli S, Carbel S (1966) Action neuro-psychotrope d’un nouvel antiepileptique: le Depamide [Neuropsychotropic action of a new antiepileptic: valpromide]. Ann Med Psychol Paris 124: 707–710PubMedGoogle Scholar
  37. 37.
    Post RM, Uhde TW, Roy-Byrne PP, Joffe RT (1986) Antidepressant effects of carbamazepine. Am J Psychiatry 143: 29–34PubMedGoogle Scholar
  38. 38.
    Post R, Ketter T, Uhde T, Ballenger JC (2007) Thirty years of clinical experience with carbamazepine in the treatment of bipolar illness: principles and practice. CNS Drugs 21: 47–71PubMedCrossRefGoogle Scholar
  39. 39.
    Weisler RH, Hirschfeld R, Cutler AJ, Gazda T, Ketter TA, Keck PE, Swann A, Kalali A (2006) Extended-release carbamazepine capsules as monotherapy in bipolar disorder: pooled results from two randomised, double-blind, placebo-controlled trials. CNS Drugs 20: 219–231PubMedCrossRefGoogle Scholar

Copyright information

© Birkhäuser Verlag/Switzerland 2009

Authors and Affiliations

  • Gary S. Sachs
    • 1
  • Louisa G. Sylvia
    • 1
  • Hannah G. Lund
    • 1
  1. 1.Massachusetts General HospitalBipolar Clinic and Research ProgramBostonUSA

Personalised recommendations