Paul A Vöhringer1, Michael J Ostacher, Rif S El-Mallakh, Niki S Holtzman, Sairah B Thommi, Elizabeth A Whitham, Matthew C Sullivan, Claudia F Baldassano, Fredrick K Goodwin, Ross J Baldessarini, S Nassir Ghaemi. 1. From the *Mood Disorders Program, Department of Psychiatry, Tufts University Medical Center, Boston, MA; †Department of Psychiatry, Hospital Clinico Universidad de Chile, Facultad de Medicina, Universidad de Chile, Santiago, Chile; ‡Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA; §Department of Psychiatry, College of Medicine, University of Kentucky, Louisville, KY; ∥Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, PA; ¶Center of Neuroscience, Medical Progress, and Society, The George Washington University School of Medicine, Washington, DC; #Department of Psychiatry, Harvard Medical School, Boston; **International Consortium for Bipolar Disorder Research, McLean Division of Massachusetts General Hospital, Belmont, MA; and ††Tufts University School of Medicine, Boston, MA.
Abstract
BACKGROUND: We sought to test the hypothesis that antidepressants (ADs) may show preferential efficacy and safety among patients with type II bipolar disorder (BD, BD-II) more than patients with type I BD (BD-I). METHODS:Patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, BD-I (n = 21) and BD-II (n = 49) in acute major depressive episodes were treated with ADs plus mood stabilizers to euthymia sustained for 2 months and then randomized openly to continue or discontinue ADs for up to 3 years. Outcomes were episode recurrences and changes in standardized symptom ratings. RESULTS: In follow-up averaging 1.64 years, both subgroups showed improvement in depressive episode frequency with AD continuation, but contrary to the hypothesis, more improvement was seen in BD-I than in BD-II (for type II, mean [standard deviation] decrease in depressive episodes per year, 0.21 [0.26]; for type I, mean (SD) decrease, 0.35 [0.15]). Subjects with BD-II who continued on ADs had slightly more depressive, but fewer manic/hypomanic, episodes than subjects with BD-I. No notable differences were seen in either group in time to a recurrence of mood episodes or total time-in-remission. CONCLUSIONS: The findings do not confirm the hypothesis that long-term AD treatment in patients with BP-II has better outcomes than in patients with BD-I, except somewhat lower risk of manic/hypomanic episodes.
RCT Entities:
BACKGROUND: We sought to test the hypothesis that antidepressants (ADs) may show preferential efficacy and safety among patients with type II bipolar disorder (BD, BD-II) more than patients with type I BD (BD-I). METHODS:Patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, BD-I (n = 21) and BD-II (n = 49) in acute major depressive episodes were treated with ADs plus mood stabilizers to euthymia sustained for 2 months and then randomized openly to continue or discontinue ADs for up to 3 years. Outcomes were episode recurrences and changes in standardized symptom ratings. RESULTS: In follow-up averaging 1.64 years, both subgroups showed improvement in depressive episode frequency with AD continuation, but contrary to the hypothesis, more improvement was seen in BD-I than in BD-II (for type II, mean [standard deviation] decrease in depressive episodes per year, 0.21 [0.26]; for type I, mean (SD) decrease, 0.35 [0.15]). Subjects with BD-II who continued on ADs had slightly more depressive, but fewer manic/hypomanic, episodes than subjects with BD-I. No notable differences were seen in either group in time to a recurrence of mood episodes or total time-in-remission. CONCLUSIONS: The findings do not confirm the hypothesis that long-term AD treatment in patients with BP-II has better outcomes than in patients with BD-I, except somewhat lower risk of manic/hypomanic episodes.
Authors: S Nassir Ghaemi; Michael M Ostacher; Rif S El-Mallakh; David Borrelli; Claudia F Baldassano; Mary E Kelley; Megan M Filkowski; John Hennen; Gary S Sachs; Frederick K Goodwin; Ross J Baldessarini Journal: J Clin Psychiatry Date: 2010-04 Impact factor: 4.384
Authors: Gary S Sachs; Michael E Thase; Michael W Otto; Mark Bauer; David Miklowitz; Stephen R Wisniewski; Philip Lavori; Barry Lebowitz; Mathew Rudorfer; Ellen Frank; Andrew A Nierenberg; Maurizio Fava; Charles Bowden; Terence Ketter; Lauren Marangell; Joseph Calabrese; David Kupfer; Jerrold F Rosenbaum Journal: Biol Psychiatry Date: 2003-06-01 Impact factor: 13.382
Authors: Lakshmi N Yatham; Sidney H Kennedy; Sagar V Parikh; Ayal Schaffer; David J Bond; Benicio N Frey; Verinder Sharma; Benjamin I Goldstein; Soham Rej; Serge Beaulieu; Martin Alda; Glenda MacQueen; Roumen V Milev; Arun Ravindran; Claire O'Donovan; Diane McIntosh; Raymond W Lam; Gustavo Vazquez; Flavio Kapczinski; Roger S McIntyre; Jan Kozicky; Shigenobu Kanba; Beny Lafer; Trisha Suppes; Joseph R Calabrese; Eduard Vieta; Gin Malhi; Robert M Post; Michael Berk Journal: Bipolar Disord Date: 2018-03-14 Impact factor: 6.744