Magazine article Clinical Psychiatry News

Small Study: Tamoxifen May Lift Mania in Bipolar

Magazine article Clinical Psychiatry News

Small Study: Tamoxifen May Lift Mania in Bipolar

Article excerpt

PARIS -- Tamoxifen, a drug widely used in the treatment of breast cancer, significantly reduced the manic symptoms of bipolar disorder in a randomized, placebo-controlled trial presented in a breaking news session at the annual congress of the European College of Neuropsychopharmacology.

Dr. Aysegul Yildiz-Yesiloglu reported that 14 of 29 acutely ill patients had at least a 50% reduction in their scores on standard measures of mania with tamoxifen treatment. Only 1 of 21 patients improved on placebo during the 3-week trial. Depressive symptoms were not affected.

While tamoxifen use in breast cancer is based on its antiestrogen effects, the investigators were drawn to the drug's activity as a protein kinase C (PKC) inhibitor, according to Dr. Yildiz-Yesiloglu, of Dokuz Eylul University in Izmir, Turkey, where the study was conducted.

She said the researchers hypothesized that inhibiting the PKC pathway could be important in bipolar disorder because lithium and valproate interfere with PKC signaling. For reasons not well understood, both mood stabilizers can reduce mania despite being structurally different.

Tamoxifen was chosen for the trial because it is the only direct PKC inhibitor approved for use in humans. It had been well tolerated in a pilot study that reported amelioration of manic symptoms in five of seven bipolar patients in the neuropsychiatric research unit at the Detroit Medical Center (Arch. Gen. Psychiatry 2000;57:95-7).

Dr. Yildiz-Yesiloglu, currently at Harvard Medical School in Boston, and her colleagues randomized 67 manic patients in the double-blind study. All had provided written consent together with at least one first-degree relative.

Six patients in the tamoxifen group and 11 patients in the placebo group dropped out because of severity of symptoms. This left 29 patients randomized to tamoxifen and 21 to placebo who completed the trial. …

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