All Title Author
Keywords Abstract


Antidepressant Treatment for Acute Bipolar Depression: An Update

DOI: 10.1155/2012/684725

Full-Text   Cite this paper   Add to My Lib

Abstract:

While studies in the past have focused more on treatment of the manic phase of bipolar disorder (BD), recent findings demonstrate the depressive phase to be at least as debilitating. However, in contrast to unipolar depression, depression in bipolar patients exhibits a varying response to antidepressants, raising questions regarding their efficacy and tolerability. Methods. We conducted a MEDLINE and Cochrane Collaboration Library search for papers published between 2005 and 2011 on the subject of antidepressant treatment of bipolar depression. Sixty-eight articles were included in the present review. Results. While a few studies did advocate the use of antidepressants, most well-controlled studies failed to show a robust effect of antidepressants in bipolar depression, regardless of antidepressant class or bipolar subtype. There was no significant increase in the rate of manic/hypomanic switch, especially with concurrent use of mood stabilizers. Prescribing guidelines published in recent years rely more on atypical antipsychotics, especially quetiapine, as a first-line therapy. Conclusions. Antidepressants probably have no substantial role in acute bipolar depression. However, in light of conflicting results between studies, more well-designed trials are warranted. 1. Introduction Bipolar disorder (BD) is a devastating illness, carrying an immense burden of both morbidity [1] and all-cause mortality [2], including high rates of completed suicide [3]. With a lifetime prevalence of 1.5–2% in Europe [4] and a similar prevalence in the USA [5], much attention has been drawn to assessing potential treatments for alleviating the symptoms of this condition, manic and depressive alike. However, while clinical focus in the past tended to be more on the manic phase of the disorder, recent findings illustrate the need to focus on effective treatment strategies for the depressive phase, for several reasons. First, observations of the natural course of BD show the considerable amount of time spent in the depressive phase compared to the manic phase (30% on average compared to 10% in bipolar 1 disorder) [6], leading to severe morbidity, including a marked occupational impairment [7]. Second, the depressive phase of BD is more prone to suicide [8]. Incomplete remission, with enduring subsyndromal depressive symptoms, has been demonstrated both to cause functional impairment [9] and increase the risk of relapse [10], emphasizing the importance of optimizing the treatment for the depressive phase of BD. Since their conception, antidepressants have been the mainstay of

References

[1]  L. L. Judd, H. S. Akiskal, P. J. Schettler et al., “Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study,” Archives of General Psychiatry, vol. 62, no. 12, pp. 1322–1330, 2005.
[2]  C. J. Murray and A. D. Lopez, “Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study,” The Lancet, vol. 349, no. 9064, pp. 1498–1504, 1997.
[3]  L. Tondo, G. Isacsson, and R. J. Baldessarini, “Suicidal behaviour in bipolar disorder: risk and prevention,” CNS Drugs, vol. 17, no. 7, pp. 491–511, 2003.
[4]  S. Pini, V. de Queiroz, D. Pagnin et al., “Prevalence and burden of bipolar disorders in European countries,” European Neuropsychopharmacology, vol. 15, no. 4, pp. 425–434, 2005.
[5]  K. E. Merikangas, H. S. Akiskal, J. Angst et al., “Lifetime and 12-month prevalence of bipolar spectrum disorder in the national comorbidity survey replication,” Archives of General Psychiatry, vol. 64, no. 5, pp. 543–552, 2007.
[6]  L. L. Judd, H. S. Akiskal, P. J. Schettler et al., “The long-term natural history of the weekly symptomatic status of bipolar I disorder,” Archives of General Psychiatry, vol. 59, no. 6, pp. 530–537, 2002.
[7]  R. C. Kessler, H. S. Akiskal, M. Ames et al., “Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers,” American Journal of Psychiatry, vol. 163, no. 9, pp. 1561–1568, 2006.
[8]  H. M. Valtonen, K. Suominen, J. Haukka et al., “Differences in incidence of suicide attempts during phases of bipolar I and II disorders,” Bipolar Disorders, vol. 10, no. 5, pp. 588–596, 2008.
[9]  L. L. Altshuler, M. J. Gitlin, J. Mintz, K. L. Leight, and M. A. Frye, “Subsyndromal depression is associated with functional impairment in patients with bipolar disorder,” Journal of Clinical Psychiatry, vol. 63, no. 9, pp. 807–811, 2002.
[10]  R. H. Perlis, M. J. Ostacher, J. K. Patel et al., “Predictors of recurrence in bipolar disorder: primary outcomes from the systematic treatment enhancement program for bipolar disorder (STEP-BD),” American Journal of Psychiatry, vol. 163, no. 2, pp. 217–224, 2006.
[11]  R. J. Baldessarini, L. Leahy, S. Arcona, D. Gause, W. Zhang, and J. Hennen, “Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders,” Psychiatric Services, vol. 58, no. 1, pp. 85–91, 2007.
[12]  J. F. Goldberg and C. J. Truman, “Antidepressant-induced mania: an overview of current controversies,” Bipolar Disorders, vol. 5, no. 6, pp. 407–420, 2003.
[13]  J. D. Amsterdam and J. Shults, “Comparison of fluoxetine, olanzapine, and combined fluoxetine plus olanzapine initial therapy of bipolar type I and type II major depression—lack of manic induction,” Journal of Affective Disorders, vol. 87, no. 1, pp. 121–130, 2005.
[14]  S. L. McElroy, R. H. Weisler, W. Chang et al., “A double-blind, placebo-controlled study of quetiapine and paroxetine as monotherapy in adults with bipolar depression (EMBOLDEN II),” Journal of Clinical Psychiatry, vol. 71, no. 2, pp. 163–174, 2010.
[15]  J. D. Amsterdam and J. Shults, “Efficacy and mood conversion rate of short-term fluoxetine monotherapy of bipolar II major depressive episode,” Journal of Clinical Psychopharmacology, vol. 30, no. 3, pp. 306–311, 2010.
[16]  G. Parker, L. Tully, A. Olley, and D. Hadzi-Pavlovic, “SSRIs as mood stabilizers for bipolar II disorder? a proof of concept study,” Journal of Affective Disorders, vol. 92, no. 2-3, pp. 205–214, 2006.
[17]  J. D. Amsterdam and J. Shults, “Comparison of short-term venlafaxine versus lithium monotherapy for bipolar II major depressive episode: a randomized open-label study,” Journal of Clinical Psychopharmacology, vol. 28, no. 2, pp. 171–181, 2008.
[18]  J. D. Amsterdam, C. H. Wang, M. Shwarz, and J. Shults, “Venlafaxine versus lithium monotherapy of rapid and non-rapid cycling patients with bipolar II major depressive episode: a randomized, parallel group, open-label trial,” Journal of Affective Disorders, vol. 112, no. 1–3, pp. 219–230, 2009.
[19]  J. D. Amsterdam, G. Wang, and J. Shults, “Venlafaxine monotherapy in bipolar type II depressed patients unresponsive to prior lithium monotherapy,” Acta Psychiatrica Scandinavica, vol. 121, no. 3, pp. 201–208, 2010.
[20]  J. D. Amsterdam and F. Garcia-Espa?a, “Venlafaxine monotherapy in women with bipolar II and unipolar major depression,” Journal of Affective Disorders, vol. 59, no. 3, pp. 225–229, 2000.
[21]  V. Agosti and J. W. Stewart, “Efficacy and safety of antidepressant monotherapy in the treatment of bipolar-II depression,” International Clinical Psychopharmacology, vol. 22, no. 5, pp. 309–311, 2007.
[22]  H. J. Gijsman, J. R. Geddes, J. M. Rendell, W. A. Nolen, and G. M. Goodwin, “Antidepressants for bipolar depression: a systematic review of randomized, controlled trials,” American Journal of Psychiatry, vol. 161, no. 9, pp. 1537–1547, 2004.
[23]  G. M. Goodwin, “Evidence-based guidelines for treating bipolar disorder: recommendations from the British association for psychopharmacology,” Journal of Psychopharmacology, vol. 17, no. 2, pp. 149–173, 2003.
[24]  American Psychiatric Association, “Practice guideline for the treatment of patients with bipolar disorder (revision),” American Journal of Psychiatry, vol. 159, supplement 4, pp. 1–50, 2002.
[25]  J. C. Fetter and K. D. Askland, “Antidepressants for bipolar depression,” The American Journal of Psychiatry, vol. 162, no. 8, pp. 1546–1568, 2005.
[26]  P. Masand and R. Mago, “Review: in people with bipolar disorder, short term antidepressants improve clinical response, although tricyclics risk inducingmania,” Evidence-Based Mental Health, vol. 8, no. 2, p. 35, 2005.
[27]  A. Schaffer, P. Zuker, and A. Levitt, “Randomized, double-blind pilot trial comparing lamotrigine versus citalopram for the treatment of bipolar depression,” Journal of Affective Disorders, vol. 96, no. 1-2, pp. 95–99, 2006.
[28]  M. Fonseca, J. C. Soares, J. P. Hatch, A. P. Santin, and F. Kapczinski, “An open trial of adjunctive escitalopram in bipolar depression,” Journal of Clinical Psychiatry, vol. 67, no. 1, pp. 81–86, 2006.
[29]  G. S. Sachs, A. A. Nierenberg, J. R. Calabrese et al., “Effectiveness of adjunctive antidepressant treatment for bipolar depression,” New England Journal of Medicine, vol. 356, no. 17, pp. 1711–1722, 2007.
[30]  C. J. Truman, J. F. Goldberg, S. N. Ghaemi et al., “Self-reported history of manic/hypomanic switch associated with antidepressant use: data from the systematic treatment enhancement program for bipolar disorder (STEP-BD),” Journal of Clinical Psychiatry, vol. 68, no. 10, pp. 1472–1479, 2007.
[31]  L. L. Altshulesr, T. Suppes, D. O. Black et al., “Lower switch rate in depressed patients with bipolar II than bipolar I disorder treated adjunctively with second-generation antidepressants,” American Journal of Psychiatry, vol. 163, no. 2, pp. 313–315, 2006.
[32]  M. M. Sidor and G. M. MacQueen, “Antidepressants for the acute treatment of bipolar depression: a systematic review and meta-analysis,” Journal of Clinical Psychiatry, vol. 72, no. 2, pp. 156–167, 2011.
[33]  M. Tohen, E. Vieta, J. Calabrese et al., “Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression,” Archives of General Psychiatry, vol. 60, no. 11, pp. 1079–1088, 2003.
[34]  M. Tohen, E. Vieta, J. Calabrese et al., “Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression,” Archives of General Psychiatry, vol. 61, no. 2, pp. 168–176, 2004.
[35]  R. C. Shelton and S. M. Stahl, “Risperidone and paroxetine given singly and in combination for bipolar depression,” Journal of Clinical Psychiatry, vol. 65, no. 12, pp. 1715–1719, 2004.
[36]  C. B. Nemeroff, D. L. Evans, L. Gyulai et al., “Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression,” American Journal of Psychiatry, vol. 158, no. 6, pp. 906–912, 2001.
[37]  J. B. Cohn, G. Collins, E. Ashbrook, and J. F. Wernicke, “A comparison of fluoxetine imipramine and placebo in patients with bipolar depressive disorder,” International Clinical Psychopharmacology, vol. 4, no. 4, pp. 313–322, 1989.
[38]  J. M. Himmelhoch, C. Z. Fuchs, and B. J. Symons, “A double-blind study of tranylcypromine treatment of major anergic depression,” Journal of Nervous and Mental Disease, vol. 170, no. 10, pp. 628–634, 1982.
[39]  J. Mendlewicz and M. B. Youdim, “Antidepressant potentiation of 5-hydroxytryptophan by L-deprenil in affective illness,” Journal of Affective Disorders, vol. 2, no. 2, pp. 137–146, 1980.
[40]  R. M. Post, L. L. Altshuler, G. S. Leverich et al., “Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline,” British Journal of Psychiatry, vol. 189, pp. 124–131, 2006.
[41]  M. Pilhatsch, R. Wolf, C. Winter, U. Lewitzka, and M. Bauer, “Comparison of paroxetine and amitriptyline as adjunct to lithium maintenance therapy in bipolar depression: a reanalysis of a randomized, double-blind study,” Journal of Affective Disorders, vol. 126, no. 3, pp. 453–457, 2010.
[42]  M. L. van der Loos, P. Mulder, E. G. Hartong et al., “Efficacy and safety of two treatment algorithms in bipolar depression consisting of a combination of lithium, lamotrigine or placebo and paroxetine,” Acta Psychiatrica Scandinavica, vol. 122, no. 3, pp. 246–254, 2010.
[43]  U.S Department of Health & Human Services and U.S Food & Drug Administration, Symbyax Product Label #NDA21-520.
[44]  L. Shi, M. A. Namjoshi, R. Swindle et al., “Effects of olanzapine alone and olanzapine/fluoxetine combination on health-related quality of life in patients with bipolar depression: secondary analyses of a double-blind, placebo-controlled, randomized clinical trial,” Clinical Therapeutics, vol. 26, no. 1, pp. 125–134, 2004.
[45]  R. H. Perlis, D. H. Adams, B. Fijal et al., “Genetic association study of treatment response with olanzapine/fluoxetine combination or lamotrigine in bipolar I depression,” Journal of Clinical Psychiatry, vol. 71, no. 5, pp. 599–605, 2010.
[46]  J. M. Tamayo, V. K. Sutton, M. A. Mattei et al., “Effectiveness and safety of the combination of fluoxetine and olanzapine in outpatients with bipolar depression: an open-label, randomized, flexible-dose study in puerto rico,” Journal of Clinical Psychopharmacology, vol. 29, no. 4, pp. 358–361, 2009.
[47]  E. G. Hantouche and H. S. Akiskal, “Bipolar II vs. unipolar depression: psychopathologic differentiation by dimensional measures,” Journal of Affective Disorders, vol. 84, no. 2-3, pp. 127–132, 2005.
[48]  R. Correa, H. Akiskal, W. Gilmer, A. A. Nierenberg, M. Trivedi, and S. Zisook, “Is unrecognized bipolar disorder a frequent contributor to apparent treatment resistant depression?” Journal of Affective Disorders, vol. 127, no. 1–3, pp. 10–18, 2010.
[49]  F. Benazzi and H. Akiskal, “The duration of hypomania in bipolar-II disorder in private practice: methodology and validation,” Journal of Affective Disorders, vol. 96, no. 3, pp. 189–196, 2006.
[50]  M. Berk, A. Brnabic, S. Dodd et al., “Does stage of illness impact treatment response in bipolar disorder? empirical treatment data and their implication for the staging model and early intervention,” Bipolar Disorders, vol. 13, no. 1, pp. 87–98, 2011.
[51]  P. Arvilommi, K. S. Suominen, O. K. Mantere, S. Lepp?m?ki, H. Valtonen, and E. T. Isomets?, “Adequacy of treatment received by diagnosed and undiagnosed patients with bipolar I and II disorders,” Journal of Clinical Psychiatry, vol. 68, no. 1, pp. 102–110, 2007.
[52]  M. Berk, K. Hallam, G. S. Malhi et al., “Evidence and implications for early intervention in bipolar disorder,” Journal of Mental Health, vol. 19, no. 2, pp. 113–126, 2010.
[53]  L. S. Matza, K. S. Rajagopalan, C. L. Thompson, and G. de Lissovoy, “Misdiagnosed patients with bipolar disorder: comorbidities, treatment patterns, and direct treatment costs,” Journal of Clinical Psychiatry, vol. 66, no. 11, pp. 1432–1440, 2005.
[54]  J. S. McCombs, J. Ahn, T. Tencer, and L. Shi, “The impact of unrecognized bipolar disorders among patients treated for depression with antidepressants in the fee-for-services California Medicaid (Medi-Cal) program: a 6-year retrospective analysis,” Journal of Affective Disorders, vol. 97, no. 1–3, pp. 171–179, 2007.
[55]  J. Mendlewicz, I. Massat, S. Linotte et al., “Identification of clinical factors associated with resistance to antidepressants in bipolar depression: results from an European multicentre study,” International Clinical Psychopharmacology, vol. 25, no. 5, pp. 297–301, 2010.
[56]  E. Baca-Garcia, L. Sher, M. M. Perez-Rodriguez et al., “Treatment of depressed bipolar patients with alcohol use disorders: plenty of room for improvement,” Journal of Affective Disorders, vol. 115, no. 1-2, pp. 262–268, 2009.
[57]  M. J. Ostacher, R. H. Perlis, A. A. Nierenberg et al., “Impact of substance use disorders on recovery from episodes of depression in bipolar disorder patients: prospective data from the systematic treatment enhancement program for bipolar disorder (STEP-BD),” American Journal of Psychiatry, vol. 167, no. 3, pp. 289–297, 2010.
[58]  D. E. Kemp, S. J. Ganocy, M. Brecher et al., “Clinical value of early partial symptomatic improvement in the prediction of response and remission during short-term treatment trials in 3369 subjects with bipolar I or II depression,” Journal of Affective Disorders, vol. 130, no. 1-2, pp. 171–179, 2010.
[59]  K. K. Busby and M. Sajatovic, “Patient, treatment, and systems-level factors in bipolar disorder nonadherence: a summary of the literature,” CNS Neuroscience and Therapeutics, vol. 16, no. 5, pp. 308–315, 2010.
[60]  S. N. Ghaemi, M. M. Ostacher, R. S. El-Mallakh et al., “Antidepressant discontinuation in bipolar depression: a systematic treatment enhancement program for bipolar disorder (STEP-BD) randomized clinical trial of long-term effectiveness and safety,” Journal of Clinical Psychiatry, vol. 71, no. 4, pp. 372–380, 2010.
[61]  L. L. Altshuler, R. M. Post, G. Hellemann et al., “Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression: a blinded, randomized study,” Journal of Clinical Psychiatry, vol. 70, no. 4, pp. 450–457, 2009.
[62]  R. T. Joffe, G. M. MacQueen, M. Marriott, and L. T. Young, “One-year outcome with antidepressant—treatment of bipolar depression,” Acta Psychiatrica Scandinavica, vol. 112, no. 2, pp. 105–109, 2005.
[63]  L. B. Marangell, E. B. Dennehy, S. Miyahara et al., “The functional impact of subsyndromal depressive symptoms in bipolar disorder: data from STEP-BD,” Journal of Affective Disorders, vol. 114, no. 1–3, pp. 58–67, 2009.
[64]  American Psychiatric Association (APA), Practice Guideline for the Treatment of Patients with Bipolar Disorder, American Psychiatric Association, Arlington, Va, USA, 2nd edition, 2005.
[65]  S. Kasper, J. R. Calabrese, G. Johnson et al., “International consensus group on the evidence-based pharmacologic treatment of bipolar I and II depression,” Journal of Clinical Psychiatry, vol. 69, no. 10, pp. 1632–1646, 2008.
[66]  National Institute for Health and Clinical Excellence (NICE), Clinical Guidelines: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care, National Institute for Health and Clinical Excellence, London, UK, 2009.
[67]  L. N. Yatham, S. H. Kennedy, A. Schaffer et al., “Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009,” Bipolar Disorders, vol. 11, no. 3, pp. 225–255, 2009.
[68]  G. M. Goodwin, “Evidence-based guidelines for treating bipolar disorder: revised second edition-recommendations from the British association for psychopharmacology,” Journal of Psychopharmacology, vol. 23, no. 4, pp. 346–388, 2009.
[69]  H. Grunze, E. Vieta, G. M. Goodwin et al., “The world federation of societies of biological psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2010 on the treatment of acute bipolar depression,” World Journal of Biological Psychiatry, vol. 11, no. 2, pp. 81–109, 2010.

Full-Text

comments powered by Disqus

Contact Us

service@oalib.com

QQ:3279437679

微信:OALib Journal