Thursday, March 29, 2007

Antidepressants vs. mood stabilizers vs. placebo in bipolar disorder

Since I spend many of my waking workday hours on this conundrum, I definitely had to mull over this one.

"Science Daily — For depressed people with bipolar disorder who are taking a mood stabilizer, adding an antidepressant medication is no more effective than a placebo (sugar pill), according to results published online in the New England Journal of Medicine. The results are part of the large-scale, multi-site Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a $26.8 million clinical trial funded by the National Institutes of Health's National Institute of Mental Health (NIMH)."
It is accepted knowledge that if you give a person with bipolar disorder an antidepressant without a mood stabilizer, there is as good chance you may trigger a manic episode. Often, once someone is on adequate doses of their mood stabilizer (many are available, the most well known are lithium or depakote, though I tend to like lamictal for bipolar depression), then an antidepressant medication is added to help lift up the depression without worry of mania.

This study had 366 participants. Participants were randomized to placebo, wellbutrin, or paxil. They first stabilized patients on their mood stabilizers, then added them into one of these treatment groups.

"After about 26 weeks, Sachs and colleagues found that 24 percent of those who had been randomized to the antidepressants stayed well for at least eight consecutive eeks--the study's stringent standard for recovery; 27 percent of those randomized to a placebo stayed well long enough to meet the eight-week recovery standard, indicating no difference between adding an antidepressant or adding placebo. In addition, about 10 percent of each group experienced emerging symptoms of mania, indicating that the antidepressants did not trigger a manic switch any more than placebo. Finally, when comparing the two antidepressants to each other, both showed similar rates of response and manic switch."
If their findings are reproducible, it could lead to changes in clinical practice which would definitely simplify things. Fewer different drugs means less polypharmacy, which is a good thing. Unfortunately, it still doesn't give us many good options for managing the depression in bipolar people.

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