Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Therapy for depression in bipolar affective disorder

https://doi.org/10.14412/2074-2711-2016-2-36-43

Full Text:

Abstract

Objective: to evaluate the efficiency and safety of different therapy regimens for depression in relation to the clinical type of bipolar affective disorders (BAD) and to choose optimal treatment regimens for depression in BAD type I (BADI) and BAD type II (BADII).

Patients and methods. A total of 65 depressive patients, including 25 with BADI and 37 with BADII, were examined. 212 depressive episodes were analyzed in BAD patients, of them there were 74 with BADI and 138 with BADII. The patients with BADI took a combination of an antidepressant (AD) and a normothymic (NT), NT and a neuroleptic (NL), AD, NT and NL. Those with BADII received monotherapy with AD or NL, a combination of AD + NT, AD + NL. The patients' status was clinically evaluated using a specially designed questionnaire and the MADRS and CGI psychometric scales at baseline and then at the end of 1, 2, 4, and 8 weeks of therapy.

Results. The AD-containing regimens used to treat patients with BADI proved to be more effective; this therapy led to a more marked reduction in depressive symptoms (55.73% in the AD + NT-treated patients; 54.07% in the AD + NT + NL group versus 33.64% in the NT + NL-treated patients), a higher response to therapy, and a larger number of remissions by the end of the investigation (80.0, 72.7, and 33.3%, respectively). Moreover, the incidence of transient hypomanic symptoms did not significantly differ in these groups (20.0, 27.3, and 8.3%, respectively). The depressive patients with BADII generally responded better to different therapy regimens (the reduction in depressive symptoms was 52.08, 58.82, 58.40, and 53.98% in the AD, NL, AD + NT, and AD + NL groups; the remission index by the end of the investigation was 60.6, 92.9, 77.8, and 69.2%, respectively); these patients were seen to have less frequently symptoms of an antipole during their treatment (18.2, 7.1, 0.0, and 15.4%, respectively).

Conclusion. The incorporation of AD into a therapy regimen in BAD patients accelerates emergence from any depression severity and considerably enhances the efficiency of treatment. According to the clinical picture of depression, both AD monotherapy (BADII) and a combination of AD + NT and/or NL (BADI, BADII) may be used. The incorporation of AD into a therapy regimen does not significantly increase a risk for developing an inverse phase. 

About the Authors

N. A. Tyuvina
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow
Russian Federation

Department of Psychiatry and Narcology

11, Rossolimo St., Build. 9, Moscow 119021 



I. G. Korobkova
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow
Russian Federation

Department of Psychiatry and Narcology

11, Rossolimo St., Build. 9, Moscow 119021 



References

1. Roy-Byrne P, Post RM, Uhde TW, et al. The longitudinal course of recurrent affective illness: life chart data from research patients at the NIMH. Acta Psychiatr Scand Suppl. 1985;317:1-34.

2. Angst J, Sellaro R, Merikangas KR. Depressive spectrum diagnoses. Compr Psychiatry. 2000 Mar-Apr;41(2 Suppl 1):39-47.

3. Hirschfeld RM. The unrecognized side of bipolar disorder. Am J Psychiatry. 2013 Aug;170(8):815-7. doi: 10.1176/appi.ajp. 2013.13050656.

4. Мосолов СН. Биполярное аффективное расстройство: диагностика и терапия. Мо- сква: МЕДпресс-информ; 2008. 384 с. [Mosolov SN. Bipolyarnoe affektivnoe rasstroistvo: diagnostika i terapiya [Bipolar affective dis￾order: diagnosis and therapy]. Moscow: MEDpress-inform; 2008. 384 p.]

5. Wehr TA, Goodwin FK. Can antidepressants cause mania and worsen the course of affective illness? Am J Psychiatry. 1987;144(11):1403-11.

6. Altshuler LL, Post RM, Leverich GS, et al. Antidepressant-induced mania and cycle acceleration: a controversy revisited. Am J Psychiatry. 1995;152(8):1130-8.

7. Tondo L, Hennen J, Baldessarini RJ. Rapid-cycling bipolar disorder: effects of longterm treatments. Acta Psychiatr Scand. 2003;108(1):4-14.

8. Akiskal HS, Pinto O. The evolving bipolar spectrum: prototypes I, II, III and IV. Psychiatr Clin North Am. 1999 Sep;22(3):517-34, vii.

9. Judd LL, Akiskal HS. The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord. 2003 Jan;73(1-2):123-31.

10. Judd LL, Akiskal HS, Schlettler PJ, et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002 Jun;59(6):530-7.

11. Joffe RT, MacQueen GM, Marriott M, Trevor Young L. A prospective, longitudinal study of percentage of time spent ill in patients with bipolar І or bipolar 2 disorders. Bipolar Dis. 2004;6(1):62-6.

12. Kupfer DJ, Frank E, Grochocinski VJ, et al. Stabilization in the treatment of mania, depression and mixed states. Acta Neuropsychiatr. 2000 Sep;12(3):110-4. doi: 10.1017/ S0924270800035547.

13. Kupka RW, Altshuler LL, Nolen WA, et al. Three times more days depressed than manic or hypomanic in both bipolar I and bipolar II disorder. Bipolar Disord. 2007 Aug;9(5):531-5.

14. Calabrese JR, Hirschfeld RM, Reed M, et al. Impact of bipolar disorder on a U.S. community sample. J Clin Psychiatry. 2003 Apr; 64(4):425-32.

15. Manning JS, Haykal RF, Connor PD, Akiskal HS. On the nature of depressive and anxious states in a family practice setting: the high prevalence of bipolar II and related disorders in a cohort followed longitudinally. Compr Psychiatry. 1997 Mar-Apr;38(2):102-8.

16. Kessler RC, Crum RM, Warner LA, et al. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997 Apr;54(4):313-21.

17. Swann AC, Dougherty DM, Pazzaglia PJ, et al. Impulsivity: a link between bipolar disorder and substance abuse. Bipolar Disord. 2004 Jun;6(3):204-12.

18. Jamison KR. Suicide and bipolar disorder. J Clin Psychiatry. 2000;61 Suppl 9:47-51.

19. Kupfer DJ. The increasing medical burden in bipolar disorder. JAMA. 2005 May 25;293(20):2528-30.

20. Bowden CL. A different depression: clinical distinctions between bipolar and unipolar depression. J Affect Disord. 2005 Feb;84 (2-3):117-25.

21. Benazzi F. Atypical depression in private practice depressed outpatients: a 203-case study. Compr Psychiatry. 1999 Jan-Feb;40(1):80-3.

22. Benazzi F. Prevalence of bipolar II disorder in atypical depression. Eur Arch Psychiatry Clin Neurosci. 1999;249(2):62-5.

23. Benazzi F. Depression with DSM-IV atypical features: a marker for bipolar II disorder. Eur Arch Psychiatry Clin Neurosci. 2000;250(1):53-5.

24. Mitchell PB, Wilhelm K, Parker G, et al. The clinical features of bipolar depression: a comparison with matched major depressive disorder patients. J Clin Psychiatry. 1997 May;58(5):212-6.

25. Bowden CL. Strategies to reduce misdiagnosis of bipolar depression. Psychiatr Serv. 2001;52(1):51-5.

26. Motovsky B, Pecenak J. Psychopathological characteristics of bipolar and unipolar depression – potential indicators of bipolarity. Psychiatr Danub. 2013;25(1):34-9.

27. Тювина НА, Коробкова ИГ. Сравнительная характеристика клинических особенностей депрессий при биполярном аффективном расстройстве I и II типа. Неврология, нейропсихиатрия, психосоматика. 2016;8(1):22-8. [Tyuvina NA, Korobkova IG. Comparative clinical characteristics of depression in bipolar affective disorders types I and II. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2016;8(1):22-8. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711- 2016-1-22-28

28. Тювина НА, Коробкова ИГ. Клинические особенности депрессий при биполяр- ном аффективном расстройстве. Психиатрия и психофармакотерапия. 2016;(1):40-5. [Tyuvina NA, Korobkova IG. Clinical features of depression in bipolar affective disorder. Psikhiatriya i psikhofarmakoterapiya. 2016;(1):40-5. (In Russ.)].

29. Goodwin GM. Evidence-based guidelines for treating bipolar disorder: Recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2003 Jun;17(2):149-73.

30. Frances A, Kahn DA, Carpenter D, et al. The expert consensus guidelines for treating depression in bipolar disorder. J Clin Psychiatry 1998;59(4):73-9.

31. Мосолов СН, Костюкова ЕГ, Ушкалова АВ и др. Алгоритмы биологической терапии биполярного аффективного расстройства. Современная терапия психических расстройств. 2013;(4):31-9. [Mosolov SN, Kostyukova EG, Ushkalova AV, et al. Algorithms of biological therapy of bipolar affective disorder. Sovremennaya terapiya psikhicheskikh rasstroistv. 2013;(4):31-9. (In Russ.)].

32. Goldberg JF, Truman CJ. Antidepressantinduced mania: an overview of current controversies. Bipolar Disord. 2003 Dec;5(6):407-20.

33. Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. Lancet. 2013;381(9878):1672-82.

34. Altshuler L, Suppes T, Black DO, et al. Lower switch rate in depressed patients with bipolar II than bipolar I disorder treated adjunctively with second-generation antidepressants. Am J Psychiatry. 2006 Feb;163(2):313-5.

35. Peet M. Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants. Br J Psychiatry. 1994;164(4):549-50.

36. Prien RF, Klett CJ, Caffey EM. Lithium carbonate and imipramine in the prevention of affective episodes. Arch Gen Psychiatry. 1973 Sep;29(3):420-5.

37. Nemeroff CB, Evans DL, Guyulai L, et al. Double-blind, placebo controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry. 2001 Jun;158(6):906-12.

38. Sachs GS, Later В, Stoll AL, et al. A double-blind trial of bupropion versus desipramine for bipolar depression . J Clin Psychiatry. 1994 Sep;55(9):391-3.

39. Montgomery SA. Long-term treatment with SSRIs. Clin Neuropharmacol. 1992;15 Suppl 1 Pt A:450A-451A.

40. Post RM, Altshuler LL, Leverich GS, et al. Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry. 2006 Aug;189:124-31.

41. Amsterdam JD, Shults J. Comparison of short-term venlafaxine versus lithium monotherapy for bipolar II major depressive episode: a randomized open-label study. J Clin Psychopharmacol. 2008 Apr;28(2):171-81. doi: 10.1097/JCP.0b013e318166c4e6.

42. Александров АА. Принципы терапии биполярной депрессии. Вестник БПА. 2007;(12):45-55. [Aleksandrov AA. Principles of therapy of bipolar depression. Vestnik BPA. 2007;(12):45-55. (In Russ.)].

43. Тювина НА, Смирнова ВН. Сравнительная оценка эффективности вальдоксана (агомелатин) при рекуррентной депрессии и биполярном аффективном расстройстве. Журнал неврологии и психиатрии им. С.С. Корсакова. 2012;(11):53-60. [Tyuvina NA, Smirnova VN. Comparative evaluation of efficacy of valdoxan (agomelatine) in recurrent depression and bipolar affective disorder. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2012;(11):53-60. (In Russ.)].

44. Мосолов СН, Костюкова ЕГ, Городничев АВ и др. Эффективность и переносимость агомелатина при депрессивных состояниях. Биологические методы терапии психических расстройств. В кн.: Мосолов СН, редактор. Доказательная медицина – клинической практике. Москва: Социально-политическая мысль; 2012. С. 387–437. [Mosolov SN, Kostyukova EG, Gorodnichev AV, et al. Efficacy and tolerability of agomelatine in depressive states. Biological therapies of mental disorders. In.: Mosolov SN, redaktor. Dokazatel'naya meditsina – klinicheskoi praktike [Evidence-based medicine for clinical practice]. Moskva: Sotsial'no-politicheskaya mysl'; 2012. P. 387–437.]


For citation:


Tyuvina N.A., Korobkova I.G. Therapy for depression in bipolar affective disorder. Neurology, Neuropsychiatry, Psychosomatics. 2016;8(2):36-43. (In Russ.) https://doi.org/10.14412/2074-2711-2016-2-36-43

Views: 986


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)