Beneficial acute antidepressant effects of aripiprazole as an adjunctive treatment or monotherapy in bipolar patients unresponsive to mood stabilizers: results from a 16-week open-label trial

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.

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Breathing-focused Yoga as Augmentation for Unipolar and Bipolar Depression: A Randomized Controlled Trial: Le yoga axé sur la respiration comme traitement d’appoint pour la dépression unipolaire et bipolaire: Un essai randomisé contrôlé

The Canadian Journal of Psychiatry ◽

10.1177/0706743720940535 ◽

2020 ◽

pp. 070674372094053

Author(s):

Arun V. Ravindran ◽

Martha S. McKay ◽

Tricia da Silva ◽

Claudia Tindall ◽

Tiffany Garfinkel ◽

...

Keyword(s):

Depressive Symptoms ◽

Rating Scale ◽

Bipolar Depression ◽

Controlled Trial ◽

Well Being ◽

Mood Stabilizers ◽

Adjunctive Treatment ◽

Residual Symptoms ◽

Significant Difference ◽

Bipolar Patients

Objective: Patients with depression frequently experience persistent residual symptoms even with optimal interventions. These patients often use complementary treatments, including yoga, as a preferred alternative or adjunctive treatment. There is evidence for the benefit of yoga for depression, but this has not been rigorously evaluated, particularly in bipolar depression. We aimed to determine the feasibility and benefit of manualized breathing-focused yoga in comparison to psychoeducation as augmentation to pharmacotherapy for improving residual symptoms of depression in unipolar and bipolar patients. Methods: Using a randomized single-blind crossover design, 72 outpatients with unipolar or bipolar depression were augmented with the two 8-week interventions at separate times, as add-ons to current first-line antidepressants and mood stabilizers. The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale (MADRS). Due to the high dropout of participants after crossover at Week 8, analysis focused on between-group comparisons of yoga and psychoeducation during the initial 8 weeks of the study. Results: There was a significant decline in depressive symptoms, as measured by the MADRS, following 8 weeks of yoga. However, there was no significant difference in MADRS ratings between intervention groups. Similar improvements in self-rated depressive symptoms and well-being were also observed across time. Conclusions: Both yoga and psychoeducation may improve residual symptoms of unipolar and bipolar depression as add-on to medications. In-class group sessions and long study durations may reduce feasibility for this population. Larger trials with parallel group design and shorter duration may be more feasible.

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Adjunctive gabapentin treatment of bipolar disorder

European Psychiatry ◽

10.1016/s0924-9338(00)00514-9 ◽

2000 ◽

Vol 15 (7) ◽

pp. 433-437 ◽

Cited By ~ 29

Author(s):

E Vieta ◽

A Martinez-Arán ◽

E Nieto ◽

F Colom ◽

M Reinares ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Social Withdrawal ◽

Poor Response ◽

Mood Stabilizers ◽

Open Label ◽

Residual Symptoms ◽

Incomplete Response ◽

Frequent Relapses ◽

Bipolar Patients

IntroductionThe aim of this study was to analyze the effectiveness of gabapentin administration to bipolar patients who had an incomplete response to other mood stabilizers.Subjects and methodsTwenty-two RDC bipolar 1 and II patients were assessed by means of the SADS and entered if they gave their consent to participate. All them had suffered from frequent relapses, subsyndromal features (mostly depressive) and incomplete response to other drugs. They all received open-label increasing doses of gabapentin until clinical response. The patients were assessed through the CGI-BP and a specific questionnaire at baseline and at 12 weeks of follow-up.ResultsSix out of the 22 patients dropped out for various reasons (four because of relapse, one because of side effects and one more because of poor compliance). Eight of the 16 patients that completed the 12-week follow-up showed at least two stages of improvement in the CGI. Using the last observation-carried forward analysis, the improvement was statistically significant for the depression subscale, and apparently related to social functioning, irritability and anxiety. Only one patient dropped out because of intolerance (mild rash). The mean dose of gabapentin was 1,310 mg/day.ConclusionGabapentin may be a useful drug for the add-on treatment of bipolar patients with poor response to other mood stabilizers. Gabapentin may improve depressive residual symptoms such as irritability, social withdrawal or anxiety. These results should be confirmed in randomized clinical trials.

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