Hostname: page-component-77c89778f8-sh8wx Total loading time: 0 Render date: 2024-07-21T23:11:25.470Z Has data issue: false hasContentIssue false

Antidepressant Effect of Mood Stabilizers

Published online by Cambridge University Press:  07 November 2014

Extract

Bipolar depression certainly poses the greatest challenge to clinicians treating bipolar patients. Having a widespread disability associated with it, bipolar depression is often chronic, is less responsive to medication treatment, and has a particularly high rate of suicide. There are currently no drugs approved by the Food and Drug Administration for the treatment of bipolar depression, although full trials have been conducted with lithium, the antipsychotic olan-zapine, and the antiepileptic (AED) lamotrigine. Data for the other AEDs are quite limited and not controlled. The American Psychiatric Association guidelines recommends maximizing the dose in patients who are already on a mood stabilizer and initiating lithium or lamotrigine in patients who are not on a mood stabilizer.

Zornberg and Pope reviewed nine studies comparing lithium to placebo in bipolar depression. Among the 145 patients in these studies, there was detectable response in 79% and an unequivocal response in 36%. Although the studies varied in their methodological design and rigor, they argue quite strongly that lithium is an effective anti-depressant. In addition, six of the seven pre1990 studies evaluating lithium for bipolar depression indicated that the drug had significant antidepressant effects.

The most recent study of lithium for bipolar depression randomly assigned 117 outpatients with acute bipolar depression to treatment with either placebo, Imipramine, or paroxetine. At the 10-week study endpoint, lithium monotherapy was as effective as the addition of an antidepressant, suggesting lithium's antidepressant properties.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Judd, LL, HS, Akiskal. The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database caking into account sub-threshold cases. J Affect Disord. 2003;73(1–2):123131.CrossRefGoogle Scholar
2.Hirschfeld, RA, Bowden, CL, Gitlin, MJ, et al.Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry. 2002;159:150.Google Scholar
3.Zornberg, GL, Pope, HG Jr.Treatment of depression in bipolar disorder: new directions for research. J Clin Psychopharmacol. 1993;13:397408.CrossRefGoogle ScholarPubMed
4.Goodwin, FK, KR, Jamison. Manic-Depressive Illness. New York, NY: Oxford University Press, Inc; 1990.Google Scholar
5.Nemeroff, CB, Evans, DL, Gyulai, L, et al.Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry. 2001;158:906912.Google ScholarPubMed
6.Baldessarini, RJ, Tondo, L, Hennen, J. Effects of lithium treatment and its discontinuation on suicidal behavior in bipolar manic-depressive disorders. J Clin Psychiatry. 1999;60(suppl 2):7784.Google ScholarPubMed
7.Goodwin, FK, Fireman, F, Simon, GE, Hunkeler, EM, Lee, J, Revicki, D. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA. 2003;11:14671473.CrossRefGoogle Scholar
8.Calabrese, JR, Bowden, CL, Sachs, GS, Ascher, JA, Monaghan, E, GD, Rudd. A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group. J Clin Psychiatry, 1999;60:7988.CrossRefGoogle ScholarPubMed
9.Frye, MA, Ketter, TA, Kimbrell, TA, et al.A placebo-controlled study of lamotrig-ine and gabapentin monothetapy in refractory mood disorders. J Clin Psychopharmacol. 2000;20:607614.CrossRefGoogle Scholar
10.McElroy, SL, Keck, PE Jr., HG, Pope Jr., JI, Hudson. Valproate in psychiatric disorders: literature review and clinical guidelines. J Clin Psychiatry. 1989;50(supp 1):2329.Google ScholarPubMed
11.PA, Lambert. Acute and prophylactic therapies of patients with affective disorders using valpromide (dipropylacetamide). In: Emtich, HM, Okuma, T, Muller, AA, eds. Anticonvulsants in Affective Disorders. Amsterdam: Elsevier Science Publishers; 1984:3344.Google Scholar
12.Sachs, G. Divalproex monotherapy in bipolar depression. Poster presented at: Annual Meeting of the American College of Neuropsychopharmacology; 12 2001; San Juan, Puerto Rico.Google Scholar
13.Young, LT, Joffe, RT, Robb, JC, MacQueen, GM, Marriott, M, Patelis-Siotis, I. Double -blind comparison of addition of a second mood stabilizer versus an anti-depressant to an initial mood stabilizer for treatment of patients with bipolar depression. Am J Psychiatry. 2000;157:124126.CrossRefGoogle Scholar
14.McIntyre, RS, Mancini, DA, McCann, S, Srinivasan, J, Sagman, D, Kennedy, D. Topiramate versus bupropion SR when added to mood stabilizer therapy for the depressive phase of bipolar disorder: a preliminary single-blind study. Bipolar Disord. 2002;3:207213.CrossRefGoogle Scholar