Psychopharmacology of Bipolar II Depression and Bipolar Depression with Mixed Features

2014 ◽  
Vol 12 (2) ◽  
pp. 136-145
Author(s):  
Honor Hsin ◽  
Trisha Suppes
Keyword(s):  
Bipolar Depression ◽  
Bipolar Ii ◽  
Mixed Features

scholarly journals Bipolar Affective Disorder and Migraine

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Birk Engmann
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Treatment Options ◽  
Bipolar Affective Disorder ◽  
Mood Stabilizer ◽  
High Rate ◽  
First Choice ◽  
Bipolar Ii ◽  
Behavioural Factors ◽  
The Relationship

This paper consists of a case history and an overview of the relationship, aetiology, and treatment of comorbid bipolar disorder migraine patients. A MEDLINE literature search was used. Terms for the search were bipolar disorder bipolar depression, mania, migraine, mood stabilizer. Bipolar disorder and migraine cooccur at a relatively high rate. Bipolar II patients seem to have a higher risk of comorbid migraine than bipolar I patients have. The literature on the common roots of migraine and bipolar disorder, including both genetic and neuropathological approaches, is broadly discussed. Moreover, bipolar disorder and migraine are often combined with a variety of other affective disorders, and, furthermore, behavioural factors also play a role in the origin and course of the diseases. Approach to treatment options is also difficult. Several papers point out possible remedies, for example, valproate, topiramate, which acts on both diseases, but no first-choice treatments have been agreed upon yet.

scholarly journals Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review

2021 ◽  
Vol 11 ◽  
pp. 204512532110458
Author(s):  
Frank M.C. Besag ◽  
Michael J. Vasey ◽  
Aditya N. Sharma ◽  
Ivan C.H. Lam
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Controlled Trial ◽  
Symptom Control ◽  
Bipolar Affective Disorder ◽  
Randomised Trial ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Mesh Terms ◽  
Bipolar Ii

Background: Bipolar disorder (BD) is a cyclic mood disorder characterised by alternating episodes of mania/hypomania and depression interspersed with euthymic periods. Lamotrigine (LTG) demonstrated some mood improvement in patients treated for epilepsy, leading to clinical studies in patients with BD and its eventual introduction as maintenance therapy for the prevention of depressive relapse in euthymic patients. Most current clinical guidelines include LTG as a recommended treatment option for the maintenance phase in adult BD, consistent with its global licencing status. Aims: To review the evidence for the efficacy and safety of LTG in the treatment of all phases of BD. Methods: PubMed was searched for double-blind, randomised, placebo-controlled trials using the keywords: LTG, Lamictal, ‘bipolar disorder’, ‘bipolar affective disorder’, ‘bipolar I’, ‘bipolar II’, cyclothymia, mania, manic, depression, depressive, ‘randomised controlled trial’, ‘randomised trial’, RCT and ‘placebo-controlled’ and corresponding MeSH terms. Eligible articles published in English were reviewed. Results: Thirteen studies were identified. The strongest evidence supports utility in the prevention of recurrence and relapse, particularly depressive relapse, in stabilised patients. Some evidence suggests efficacy in acute bipolar depression, but findings are inconsistent. There is little or no strong evidence in support of efficacy in acute mania, unipolar depression, or rapid-cycling BD. Few controlled trials have evaluated LTG in bipolar II or in paediatric patients. Indications for safety, tolerability and patient acceptability are relatively favourable, provided there is slow dose escalation to reduce the probability of skin rash. Conclusion: On the balance of efficacy and tolerability, LTG might be considered a first-line drug for BD, except for acute manic episodes or where rapid symptom control is required. In terms of efficacy alone, however, the evidence favours other medications.

scholarly journals 108 Lurasidone in Children and Adolescents With Bipolar Depression Presenting With Mixed Features

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 70-70
Author(s):  
Cynthia Siu ◽  
Andrei Pikalov ◽  
Michael Tocco ◽  
Antony Loebel
Keyword(s):  
Children And Adolescents ◽  
Effect Size ◽  
Repeated Measures ◽  
Mixed Model ◽  
Rating Scale ◽  
Bipolar Depression ◽  
Depression Score ◽  
Double Blind ◽  
Increased Risk ◽  
Mixed Features

AbstractObjectiveTo evaluate the efficacy and safety of lurasidone in the treatment of children and adolescents with bipolar depression presenting with mixed features.MethodsPatients 10 to 17 years of age, inclusive, with a DSM-IV-TR diagnosis of bipolar I depression, were randomized to 6 weeks of double-blind treatment with once-daily, flexible doses of lurasidone 20-80 mg or placebo. The presence of mixed features (subthreshold hypomanic symptoms) was defined as a YMRS score > 5 at study baseline. Efficacy analyses included change from baseline to week 6 in Children Depression Rating Scale, Revised (CDRS-R) score (the primary outcome), and Clinical Global Impressions, Bipolar Severity of Depression Score (CGI-BP-S), using mixed model for repeated measures (MMRM) analysis.ResultsAt baseline, mixed features were present in 54.2% of patients (lurasidone, n=97/173; placebo, n=89/170). Treatment with lurasidone (vs placebo) was associated with significantly greater reductions in CDRS-R scores at week 6 in the mixed features group (-21.5 vs -15.9; P<0.01; effect size, 0.45), and in the group without mixed features (-20.4 vs -14.8; P<0.01; effect size, 0.45). Likewise, lurasidone was associated with greater effect size (vs placebo) for reductions inCGI-BP-S scores at week 6 in the mixed features group (-1.6 vs -1.1; P<0.001; effect size 0.57), and in the group without mixed features (-1.3 vs -1.0; P=0.05; effect size 0.30). Rates of protocol-defined treatment-emergent hypomania or mania were similar for lurasidone and placebo in patients with mixed features(lurasidone 8.2% vs. placebo 9.0%) and without mixed features (lurasidone 1.3% vs. placebo 3.7%).ConclusionsIn this post-hoc analysis, lurasidone was found to be efficacious for treating child and adolescent patients with bipolar depression presenting with mixed features(assessed cross-sectionally at study baseline). There was no increased risk of treatment-emergent mania observed in patients with or without mixed features.Funding AcknowledgementsSunovion Pharmaceuticals Inc.

Interictal dysphoric disorder – the bridge between epilepsy and bipolar disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S126-S127
Author(s):  
R. Sousa ◽  
M. Salta ◽  
B. Barata ◽  
J. Nogueira ◽  
J. Vieira ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Classical Antiquity ◽  
Biological Processes ◽  
Bipolar Ii Disorder ◽  
Bipolar Ii ◽  
Episodic Course ◽  
Competing Interest ◽  
Patients With Epilepsy ◽  
Pituitary Adrenal Axis

IntroductionPsychiatric disorders are frequent among patients with epilepsy. The association between epilepsy and mood disorders is recognized since the classical antiquity. Recent studies demonstrated that the prevalence of bipolar symptoms in epilepsy patients is more significant than previously expected. In the first half of the twentieth century, Kraeplin and Bleuler were the first to describe a pleomorphic pattern of symptoms claimed to be typical of patients with epilepsy and recently Blumer coined the term interictal dysphoric disorder to identify this condition. Although for some authors, the existence of this condition as a diagnostic entity is still doubtful, for others, it represents a phenotypic copy of bipolar disorder.ObjectivesIn this work, we start from the phenomenological similarities between the interictal dysphoric disorder and the bipolar disorder, to explore the neurobiological underpinnings that support a possible link between epilepsy and bipolar disorder.MethodsResearch of articles published in PubMed and other databases.ResultsInterictal dysphoric patients have features that resemble the more unstable forms of bipolar II disorder and benefit from the same therapy used in bipolar depression. Epilepsy and bipolar disorder share features like episodic course, the kindling phenomenon as possible pathogenic mechanisms and the response to antiepileptic drugs. The study of possible common biological processes like neurogenesis/neuroplasticity, inflammation, brain-derived-neurotrophic-factor, hypothalamus pituitary adrenal axis, provided promising but not consensual results.ConclusionsFurther efforts to understand the link between epilepsy and bipolar disorder could provide the insight needed to find common therapeutic targets and improve the treatment of both illnesses.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Bipolar depression: a major unsolved challenge

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Ross J. Baldessarini ◽  
Gustavo H. Vázquez ◽  
Leonardo Tondo
Keyword(s):  
General Population ◽  
Psychiatric Disorders ◽  
Suicide Risk ◽  
Bipolar Depression ◽  
Unipolar Depression ◽  
Short Term ◽  
Term Efficacy ◽  
Medical Disorders ◽  
Mixed Features

AbstractDepression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.

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