Options Expanding for Bipolar Disorder

By Jancin, Bruce | Clinical Psychiatry News, May 2008 | Go to article overview

Options Expanding for Bipolar Disorder


Jancin, Bruce, Clinical Psychiatry News


VIENNA -- A growing list of innovative therapies with novel mechanisms of action in bipolar disorder is available for tough-to-treat cases, Dr. Benedikt L. Amann said at the annual congress of the European College of Neuropsy-chopharmacology.

All of these candidates have demonstrated promise in open-label or small, controlled, proof-of-concept studies, but they all clearly require larger confirmatory trials. In the interim, psychiatrists are likely to find some of these agents beneficial for off-label use in the many patients with bipolar disorder who respond inadequately to current guideline-directed treatments, said Dr. Amann of the University of Barcelona.

Although he discussed promising new therapies for mania, he gave greater emphasis to progress in the treatment of bipolar depressive episodes because the need is more pressing.

"We do very well with our manic patients on a symptomatic level, but we still do very badly with depressive patients," he observed.

Options for Bipolar Depression

The wakefulness drug modafinil (Provigil) improved symptoms of bipolar depression in a recent randomized, placebo-controlled, 85-patient, multicenter study.

All enrollees were inadequately responsive to a mood stabilizer. By week 2, the modafinil-treated group, on a mean dosage of 177 mg/ day, showed significantly greater improvement than did controls on the clinician-rated Inventory of Depressive Symptomatology. The remission rate at the end of the 6-week trial was 39% in the modafinil group, compared with 18% with placebo. There was no difference between the two groups in treatment-emergent mania or hypomania (Am. J. Psychiatry 2007; 164: 1242-9).

In Dr. Amann's 2-year, open-label study of 30 patients with refractory severe bipolar depression, the nutritional supplement chromium was associated with a mean 40% decrease in Montgomery-[degree]Asberg Depression Rating Scale (MADRS) scores (J. Clin. Psychopharmacol. 2007; 27: 104-6). Like the modafinil trial, the chromium study was funded by the Stanley Medical Research Institute.

In the first double-blind, placebo-controlled trial conducted of a potential treatment for acute bipolar II depression, pramipexole (Mi-rapex) showed significant benefit, with 60% of patients treated to a target dosage of 1-3 mg/day demonstrating a greater than 50% reduction in MADRS scores after 6 weeks, compared with 9% of those on placebo. …

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