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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by SLS on October 21, 2013, at 19:46:10
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More Evidence That Regular Antidepressants Do Not Work in Bipolar Depression
October 21, 2013
Psychiatrists most commonly prescribe antidepressants for bipolar depression, but mounting evidence shows that the traditional antidepressants that are effective in unipolar depression are not effective in bipolar disorder. At the 2013 meeting of the American Psychiatric Association, researcher Jessica Lynn Warner reported that among 377 patients with Bipolar I Disorder who were discharged from a hospital, those who were prescribed an antidepressant at discharge were just as likely to be remitted for a new depression than those not given an antidepressant.
The average time to readmission also did not differ across the two groups and was 205 +/- 152 days. Those patients prescribed the serotonin and norepinephrine reuptake inhibitor (SNRI) drug venlafaxine (Effexor) were three times more likely to be readmitted than those not prescribed antidepressants.
These naturalistic data (generated from observations of what doctors normally do and information in the hospitals clinical notes) resemble those from controlled studies. In the most recent meta-analysis of antidepressants in the treatment of bipolar depression (by researchers Sidor and MacQueen), there appeared to be no benefit to adding antidepressants to ongoing treatment with a mood stabilizer over adding placebo. Randomized studies by this editor Post et al. and Vieta et al. have shown that venlafaxine is more likely to bring about switches into mania than other types of antidepressants such as bupropion or selective serotonin reuptake inhibitors (SSRIs).
In addition, a naturalistic study published by this editor Post et al. in the Journal of Clinical Psychiatry in 2012 showed that the number of times antidepressants were prescribed prior to a patients entrance into a treatment network (the Bipolar Collaborative Network) at an average age of 40 was related to their failure to achieve a good response or a remission for a duration of at least six months during prospective treatment.
Editors Note: Antidepressants are still the most widely used treatments for bipolar depression, and their popularity over more effective treatments (mood stabilizers and some atypical antipsychotics) probably contributes to the fact that patients with bipolar disorder receiving typical treatment in their communities spend three times as much time in depressions than in manic episodes. Using other treatments first before an antidepressant would appear to do more to prevent bipolar depression. These treatments include mood stabilizers (lithium, lamotrigine, carbamazepine, and valproate); the atypical antipsychotics that are FDA-approved for monotherapy in bipolar depression, lurasidone (Latuda) and quetiapine (Seroquel); and the combination of olanzapine and fluoxetine that goes by the trade name Symbiax.
Evidence from several sources suggests that the SNRI venlafaxine may be a risk factor for switches into mania and lead to re-hospitalizations. Other data suggest that in general, in bipolar depression, augmentation treated with antidepressants should be avoided in several cases: in childhood-onset bipolar depression, in mixed states, and in those with a history of rapid cycling (4 or more episodes per year).
Posted by Rahilka on October 21, 2013, at 23:08:28
In reply to Bipolar Depression and Antidepressants, posted by SLS on October 21, 2013, at 19:46:10
This is really interesting, Scott. I have always wondered why my doctor keeps putting me on antidepressants. A few months ago we did a differential diagnosis for bipolar disorder and the results were that I was "possibly" somewhere in the "bipolar spectrum". Not a very clean-cut answer. Even after this possible bipolar diagnosis he handed me a script for an SSRI - Zoloft, actually. Maybe he was trying to do the secret psychiatrist bipolar test since sertraline is known for high rates of manic switches.
After a week on 12.5 milligrams, I ended up inpatient at a psychiatric hospital.
Posted by Phillipa on October 22, 2013, at 10:19:03
In reply to Re: Bipolar Depression and Antidepressants, posted by Rahilka on October 21, 2013, at 23:08:28
I would hope not how horrible that would be to do this to someone for diagnostic purposes. Phillipa
Posted by doxogenic boy on October 22, 2013, at 12:39:49
In reply to Bipolar Depression and Antidepressants, posted by SLS on October 21, 2013, at 19:46:10
>Randomized studies by this editor Post et al. and Vieta et al. have shown that venlafaxine is more likely to bring about switches into mania than other types of antidepressants such as bupropion or selective serotonin reuptake inhibitors (SSRIs).
Here is a study with the opposite results:
http://www.ncbi.nlm.nih.gov/pubmed/19694630Acta Psychiatr Scand. 2010 Mar;121(3):201-8. Epub 2009 Aug 19.
Venlafaxine monotherapy in bipolar type II depressed patients unresponsive to prior lithium monotherapy.
Amsterdam JD, Wang G, Shults J.Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. jamsterd@mail.med.upenn.edu
Abstract
OBJECTIVE:We examine the safety and efficacy of venlafaxine monotherapy in bipolar type II (BP II) patients with major depressive episode (MDE) who were unresponsive to prior lithium monotherapy. We hypothesized that venlafaxine would be superior to lithium with a low hypomanic conversion rate.
METHOD:Seventeen patients who were unresponsive to prior lithium monotherapy were crossed to venlafaxine monotherapy for 12 weeks. The primary outcome was within-subject change in total Hamilton Depression Rating (HAM-D) score over time. Secondary outcomes included the change in Young Mania Rating (YMRS) and clinical global impressions severity (CGI/S) and change (CGI/C) scores.
RESULTS:Venlafaxine produced significantly greater reductions in HAM-D (P < 0.0005), CGI/S (P < 0.0005), and CGI/C (P < 0.0005) scores vs. prior lithium. There was no difference in mean YMRS scores between treatment conditions (P = 0.179).
CONCLUSION:Venlafaxine monotherapy may be a safe and effective monotherapy of BP II MDE with a low hypomanic conversion rate in lithium non-responders.
- doxogenic
Posted by Bob on October 22, 2013, at 21:27:15
In reply to Re: Bipolar Depression and Antidepressants » Rahilka, posted by Phillipa on October 22, 2013, at 10:19:03
I've had some doctors wonder if I might be BPII but my disease state has always been characterized by depression and that depression has gotten worse over time. I've never felt an antidepressant by the classic drugs for bipolar such as lithium, depakote and other antisiezure meds. To me these drugs only seem useful for tamping down mania or hypomania. At least, that's my personal experience.Bob
Posted by Rahilka on October 22, 2013, at 21:42:43
In reply to Re: Bipolar Depression and Antidepressants » Rahilka, posted by Phillipa on October 22, 2013, at 10:19:03
> I would hope not how horrible that would be to do this to someone for diagnostic purposes. Phillipa
Agreed, Phillipa - especially considering how the DSM says someone can have a severe manic reaction to an AD even if they are not bipolar.
So in the end the suffering wouldn't serve even the slightest purpose anyway.
Posted by SLS on October 23, 2013, at 6:31:04
In reply to Re: Bipolar Depression and Antidepressants, posted by Bob on October 22, 2013, at 21:27:15
>
> I've had some doctors wonder if I might be BPII but my disease state has always been characterized by depression and that depression has gotten worse over time. I've never felt an antidepressant by the classic drugs for bipolar such as lithium, depakote and other antisiezure meds. To me these drugs only seem useful for tamping down mania or hypomania. At least, that's my personal experience.
>
> BobHave you ever had a manic episode or a manic reaction to treatment?
Which "mood stabilizers" have you tried?
What antipsychotics have you tried?
I glean an improvement in my depression from small amounts of lithium: 300 - 450 mg/day. I have the type of bipolar disorder in which I am stuck in depression with the exception of several drug-induced severe manias.
I have learned not to take my personal theories too seriously. For example, I would not take Mirapex just because I think dopamine hypofunction is a component of my illness. On the other hand, I gave prazosin no chance of working at all. The only reason I took this drug was to humor my doctor. I was wrong in my thinking. Once I began to respond to prazosin, I researched it and found a few things that led me to another personal theory involving brain NE alpha-1b receptors.
- Scott
Posted by joef on October 23, 2013, at 6:50:43
In reply to Re: Bipolar Depression and Antidepressants » Bob, posted by SLS on October 23, 2013, at 6:31:04
I believe a good dr. would not put a bipolar patient on an ssri without a mood stabilizer.....I take Cymbalta..klonopin ..tegretol..lamictal...ocd/bp2
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