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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by jrbecker on July 1, 2003, at 14:41:09
http://biz.yahoo.com/rc/030701/health_bipolordisorder_antidepressants_1.html
http://ajp.psychiatryonline.org/cgi/content/full/160/7/1252
Reuters
Antidepressant regimen aids bipolar disorder-study
Tuesday July 1, 12:02 am ET
By Deena BeasleyLOS ANGELES, July 1 (Reuters) - Patients with bipolar disorder should continue taking antidepressants even after their symptoms have eased, researchers suggested on Tuesday in a break with standard practice.
Usual guidelines for treating the chronic disorder, also known as manic depression, recommend discontinuing antidepressants within six months of improvement.But researchers from the University of California at Los Angeles found that patients treated under those guidelines were nearly twice as likely to relapse as those who continued taking antidepressants along with mood stabilizing medication for the first year after remission of acute bipolar depression.
They also found no increased risk of manic relapse in study participants who continued the medication for a year.
Manic depression, marked by swings from euphoria to despair, is one of the most common mental illnesses, with some research suggesting it affects nearly eight million American adults.
"Psychiatrists are taught that when someone is depressed you put them an antidepressants, but when the patient is bipolar there was always a risk of inducing mania," said Mark Frye, director of UCLA's Bipolar Disorder Research Program and a co-author of the study. "Maybe we need to be thinking of antidepressants as long-term therapy for bipolar patients who were depressed and did well on medication."
The study findings appear in the July 2003 issue of the American Journal of Psychiatry.
The work was supported by the Stanley Medical Research Institute, a nonprofit organization that supports research on the causes and treatment of schizophrenia and bipolar disorder. Three pharmaceutical companies provided free medication -- including drugs such as Glaxo's Wellbutrin and Pfizer Inc.'s (NYSE:PFE - News) Zoloft -- but no other financial support.
"The common clinical practice of discontinuing antidepressant use in bipolar patients soon after remission of depression symptoms may actually increase the risk of relapse," Dr. Lori Altshuler, a professor at the UCLA Neuropsychiatric Institute and the study's lead author, said in a statement.
The U.S. Food and Drug Administration (News - Websites) last week approved Lamictal, GlaxoSmithKline Plc's (London:GSK.L - News) anti-seizure pill, as the first new maintenance therapy for bipolar disorder since the introduction of lithium in the 1970s.
The UCLA study examined 84 individuals with bipolar disorder whose depression symptoms eased with the addition of an antidepressant to an ongoing mood stabilizer, such as lithium or Eli Lilly & Co.'s (NYSE:LLY - News) Zyprexa.
At one year after improvement of depression symptoms, 70 percent of the antidepressant discontinuation group had relapsed, compared to 36 percent of the continuation group.
Posted by stjames on July 1, 2003, at 15:11:37
In reply to Study asserts Bipolars should stay on ADs longer, posted by jrbecker on July 1, 2003, at 14:41:09
Sorry, but why do you need a study to prove
that an illness, which is for life, requires
medication for life ? Duh !
Posted by Jack Smith on July 1, 2003, at 17:12:54
In reply to Re: Study asserts Bipolars should stay on ADs longer, posted by stjames on July 1, 2003, at 15:11:37
> Sorry, but why do you need a study to prove
> that an illness, which is for life, requires
> medication for life ? Duh !I think the study was aimed at disproving the popular belief among many that bipolars should only be treated long term with mood-stabilizers and should only bet treated short term with AD's. This view still seems to be correct for many.
JACK
Posted by judy1 on July 1, 2003, at 17:30:50
In reply to Study asserts Bipolars should stay on ADs longer, posted by jrbecker on July 1, 2003, at 14:41:09
actually, this study really surprised me. They didn't mention whether this group consisted of bp1 or bp2, rapid-cycling, etc. I know I'm part of a subset who cannot take an AD w/o lapsing into mania (despite being on a mood stabilizer), and I know of some studies that show ADs worsen cycling. it's a pretty intricate disorder- thanks for posting, judy
Posted by Ritch on July 1, 2003, at 23:22:01
In reply to Study asserts Bipolars should stay on ADs longer, posted by jrbecker on July 1, 2003, at 14:41:09
The study is congruent with my experience. I prefer to keep on all the meds and just adjust the doses. Coming off all AD's never has worked out well for me-over a 25-year timeframe.
Posted by colin wallace on July 2, 2003, at 4:02:37
In reply to Study asserts Bipolars should stay on ADs longer, posted by jrbecker on July 1, 2003, at 14:41:09
> http://biz.yahoo.com/rc/030701/health_bipolordisorder_antidepressants_1.html
>
> http://ajp.psychiatryonline.org/cgi/content/full/160/7/1252
>
> Reuters
> Antidepressant regimen aids bipolar disorder-study
> Tuesday July 1, 12:02 am ET
> By Deena Beasley
>
> LOS ANGELES, July 1 (Reuters) - Patients with bipolar disorder should continue taking antidepressants even after their symptoms have eased, researchers suggested on Tuesday in a break with standard practice.
>
director of UCLA's Bipolar Disorder Research Program and a co-author of the study. "Maybe we need to be thinking of antidepressants as long-term therapy for bipolar patients who were depressed and did well on medication."
>
> The study findings appear in the July 2003 issue of the American Journal of Psychiatry.
>
>Totally agree with this.Common sense and instinct have always told me that to discontinue an antidepressant(that's working well with a mood stabilizer)would be tantamount to suicide.
As I've said before, it's fine for psychiatrists to assert that discontinuing an AD will benefit in the *long* run(what's long? Month's? Years?decades of being seriously ill?!)but for the poor sucker sitting there suffering and waiting for this theory to actually *work*...well,it just doesn't.I've tried it for a good long while.You don't miraculously appear out the other end of a black tunnel and say "wow, glad I suffered that year of suicidality without any antidepressant....I suddenly feel so much better on valproate alone!!!"
This is a pipe-dream.
Posted by linkadge on July 2, 2003, at 15:09:58
In reply to Re: Study asserts Bipolars should stay on ADs longer » jrbecker, posted by colin wallace on July 2, 2003, at 4:02:37
I don't know what to do. I know I need an antidepressant and a mood stabalizer but
I cannot combine the two.Lithium + an SSRI gives me terrible vertigo.
I can't even walk straight without the bouncing
up and down effect. Have other people combined
the two without problems ???Linkadge
Posted by Ritch on July 3, 2003, at 0:01:29
In reply to Do other bipolars not have these effects ??, posted by linkadge on July 2, 2003, at 15:09:58
> I don't know what to do. I know I need an antidepressant and a mood stabalizer but
> I cannot combine the two.
>
> Lithium + an SSRI gives me terrible vertigo.
> I can't even walk straight without the bouncing
> up and down effect. Have other people combined
> the two without problems ???
>
> Linkadge
>
>
Not all SSRI are identical. Have you tried *all* of them in combo with lithium? I had some balance troubles and vertigo with Prozac+Lithium, but didn't have that trouble with Zoloft+Lithium or Effexor+Lithium. Never tried Celexa+Lithium.
Posted by bookgurl99 on July 6, 2003, at 2:54:01
In reply to Study asserts Bipolars should stay on ADs longer, posted by jrbecker on July 1, 2003, at 14:41:09
so, now that i am no longer on an ssri, i seem to be occasionally hypomanic (usually strongest for 2-4 days previous to menstruation), without a fall into depression, however, i was not 'triggered' into hypomania or mania while on an ssri.
does this mean that i can consider myself 'clear' of the fear of bp disorder? in other words, is this occasional hypomania probably a 'base state' for me?
Posted by jrbecker on July 7, 2003, at 12:28:32
In reply to question abt. ssri's and bp » jrbecker, posted by bookgurl99 on July 6, 2003, at 2:54:01
> so, now that i am no longer on an ssri, i seem to be occasionally hypomanic (usually strongest for 2-4 days previous to menstruation), without a fall into depression, however, i was not 'triggered' into hypomania or mania while on an ssri.
>
> does this mean that i can consider myself 'clear' of the fear of bp disorder? in other words, is this occasional hypomania probably a 'base state' for me?
>
>
I'm sorry, I have limited experience with full-blown hypomania. My depression is of the atypical-featured variety, which does has some overlap with bipolarity, but not in the sense that it has clear and decipherable cycles of mood (at least for me).Your question is an important one though. Ritch (mitch) or one of the other experienced BP IIer's might be more equipped to give some better insight. Any takers?
JB
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