Posted by SLS on October 29, 2000, at 10:20:49
Hi.
While doing my own literature search in an attempt to corroborate the results of that performed by JohnL in another thread, I found what looks like a very important distinction made between the age of onset of rapid-cyclicity and the drugs most likely to treat it successfully. It was a VERY small study.
On Medline, I performed a search with the following keywords:
"early AND onset AND antidepressant"
Summary of results:Definitions:
early onset = initial episode occurs at or before age 25
late onset = initial episode occurs at or after
1. For early-onset cases, Tegretol (carbamazepine) was found to be more effective than lithium.2. For late-onset cases, lithium was found to be more effective than Tegretol in controlling manic symptoms.
3. In both early-onset and late-onset groups, lithium was relatively ineffective for preventing future recurrences.
4. For early-onset cases, the time between the first affective episode and the onset of rapid-cyclicity was shorter than in late-onset.
5. For early-onset cases, the time spent in each phase of the cycle was shorter than in late-onset cases.
6. Antidepressants were more effective in treating the depressive phase of late-onset than they were for early-onset.
7. Antidepressant-induced rapid-cyclicity occurred more often in the late-onset group than the early-onset group.
Hopefully, future studies will identify in more detail the way each of these two types of rapid-cyclicity are differentially treated. Evaluating effective polypharmacy (combination-therapy) would be the next step. For example: For which group is Depakote + lithium more likely to produce a successful treatment than Tegretol + lithium?
- Scott-------------------------------------------------------------
40: J Clin Psychopharmacol 1998 Aug;18(4):282-8
Comparison of early- and late-onset rapid cycling affective disorders: clinical
course and response to pharmacotherapy.Fujiwara Y, Honda T, Tanaka Y, Aoki S, Kuroda S
Department of Neuropsychiatry, Okayama University Medical School, Japan.
This study compared the clinical course and response to pharmacotherapy of patients with rapid cycling affective disorder (RCAD). A retrospective study was conducted on outpatients with affective disorder from 1991 to 1992 at Okayama University Medical School to select cases of RCAD. The subjects were 35 patients who fulfilled DSM-III-R criteria for mood disorder and had experienced at least four episodes of illness during the previous year. The subjects were divided into two groups according to their age at the first phase of affective illness: an early-onset group, consisting of patients aged 25 years or younger, and a late-onset group, consisting of patients aged 26 or older. There were 14 patients in the early-onset group and 21 in the late-onset group. Both the mean duration from onset to rapid cycling and the mean duration of each phase were shorter in the early-onset group than in the late-onset group. There were no significant differences between the groups in period of remission, character of the first episode, heredity, or thyroid function. Lithium carbonate therapy was more effective for reducing manic symptoms in the late-onset group than in the early-onset group, without maintaining a prophylactic effect in either group, whereas carbamazepine was more effective in the early-onset group. Antidepressants used in the depressive phase had a tendency to be more effective in the late-onset than in the early-onset group. However, rapid cycling induced by antidepressants was more evident in the late-onset than in the early-onset group. These findings supported the differentiation of RCAD into two groups based on age at onset, the early-onset group showing a rapid cycling course at an early stage and a good response to carbamazepine, the late-onset group having a relatively long disease duration until the appearance of a rapid cycling course and a good response to lithium carbonate in the manic phase and to antidepressants in the depressive phase.
PMID: 9690693, UI: 98353003
poster:SLS
thread:47695
URL: http://www.dr-bob.org/babble/20001022/msgs/47695.html