Double-Blind, Placebo-Controlled Comparison of Imipramine and Paroxetine in the Treatment of Bipolar Depression

Nemeroff, Charles B.; Evans, Dwight L.; Gyulai, Laszlo; Sachs, Gary S.; Bowden, Charles L.; Gergel, I.; Oakes, Rosemary; Pitts, Cornelius D.

doi:10.1176/appi.ajp.158.6.906

Cited by 356 publications

(158 citation statements)

References 32 publications

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“…This incidence is broadly similar to that observed in other longitudinal studies such as the Stanley Foundation cohort (Frye et al, 2009;Leverich et al, 2006) when that study examined postacute treatment outcomes. Not surprisingly, rates were about twice than those observed in randomized, placebocontrolled studies (Keck et al, 2005;Nemeroff et al, 2001;Sachs et al, 2007), which considered only short-term transition to mania.…”

Section: Discussionmentioning

confidence: 72%

“…To confidently assess the risk associated with antidepressant use, randomized, double-blind, placebo-controlled trials are necessary. Of note, such trials consistently indicate risks equivalent to placebo when antidepressants are given in conjunction with antimanic treatments (Nemeroff et al, 2001;Sachs et al, 2007;Tohen et al, 2003). Similarly, risk for confounding precludes drawing conclusions about the impact of co-treatments such as antimanic agents.…”

Section: Discussionmentioning

confidence: 99%

“…For second-generation antidepressants combined with mood stabilizers, a more recent large study suggested switch rates of 12-22% during acute treatment, depending on the definition of mania used Leverich et al, 2006). In contrast, multiple recent randomized placebo-controlled trials indicate that the risk of transition during an acute treatment trial is less than 10% when antidepressants are combined with mood stabilizersFrates that are comparable to or lower than those found in placebo control conditions (Keck et al, 2005;Nemeroff et al, 2001;Sachs et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

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Transition to Mania During Treatment of Bipolar Depression

Perlis

Ostacher

Goldberg

et al. 2010

Neuropsychopharmacol

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Some individuals with bipolar disorder transition directly from major depressive episodes to manic, hypomanic, or mixed states during treatment, even in the absence of antidepressant treatment. Prevalence and risk factors associated with such transitions in clinical populations are not well established, and were examined in the Systematic Treatment Enhancement Program for Bipolar Disorder study, a longitudinal cohort study. Survival analysis was used to examine time to transition to mania, hypomania, or mixed state among 2166 bipolar I and II individuals in a major depressive episode. Cox regression was used to examine baseline clinical and sociodemographic features associated with hazard for such a direct transition. These features were also examined for interactive effects with antidepressant treatment. In total, 461/2166 subjects in a major depressive episode (21.3%) transitioned to a manic/hypomanic or mixed state before remission, including 289/1475 (19.6%) of those treated with antidepressants during the episode. Among the clinical features associated with greatest transition hazard were greater number of past depressive episodes, recent or lifetime rapid cycling, alcohol use disorder, previous suicide attempt, and history of switch while treated with antidepressants. Greater manic symptom severity was also associated with risk for manic transition among both antidepressant-treated and antidepressant-untreated individuals. Three features, history of suicide attempt, younger onset age, and bipolar subtype, exhibited differential effects between individuals treated with antidepressants and those who were not. These results indicate that certain clinical features may be associated with greater risk of transition from depression to manic or mixed states, but the majority of them are not specific to antidepressant-treated patients.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transition to Mania During Treatment of Bipolar Depression

Perlis

Ostacher

Goldberg

et al. 2010

Neuropsychopharmacol

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“…Quetiapine (level 1),241, 242, 243 lithium (level 2),244, 245, 246 lamotrigine (level 2)242, 247, 248 and lurasidone (level 2)249 are all recommended as first‐line treatment options with evidence for efficacy as monotherapy.…”

Section: Acute Management Of Bipolar Depressionmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…compararam a associação de paroxetina versus imipramina com pacientes com depressão bipolar I em uso de lítio. Nesse estudo, o grupo da paroxetina teve menos efeitos colaterais e menos viradas maníacas que no grupo da imipramina 120 . Vieta e cols.…”

Section: Depressão Bipolarunclassified

Neurobiologia do transtorno de humor bipolar e tomada de decisão na abordagem psicofarmacológica

Machado‐Vieira

Schwartzhaupt²,

Frey

et al. 2003

Rev. psiquiatr. Rio Gd. Sul

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INTRODUÇÃOO Transtorno do Humor Bipolar (THB) caracteriza-se por oscilações do humor que causam prejuízos significativos no âmbito biopsicossocial, com critérios específicos para seus subdiagnósticos (DSM-IV). O surgimento de novos fármacos com propriedade de estabilizar o humor, o refinamento diagnóstico, as estimativas de uma maior prevalência, o risco de suicídio, assim como os prejuízos sociais causados para o indivíduo portador do transtorno, sua família e a sociedade enfatizam a importân-cia de cada vez mais este transtorno ser estudado de forma sistemática, continuada e críti-ca. Este artigo avalia criticamente as opções já estudadas para tratamento farmacológico dos diferentes subtipos de THB, avaliando sua eficácia para as indicações específicas, bem como as perspectivas de novos estudos com fárma-cos que ainda apresentam resultados limitados, especialmente devido à não sistematização dos estudos clínicos feitos até o presente momento. FÁRMACOS UTILIZADOS E MECANISMOS DE AÇÃO LítioO lítio interfere no metabolismo do inositol trifosfato, responsável pela liberação do cálcio de seus depósitos intracelulares, possivelmente através da inibição de enzimas na rota de formação do inositol2,3. Há também outras hipóteses que justificam seu uso como estabilizador do humor:-por sua similaridade com outros elementos (sódio, potássio, cálcio e magnésio), eleva Neurobiologia do transtorno de humor bipolar e tomada de decisão na abordagem psicofarmacológica

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Double-Blind, Placebo-Controlled Comparison of Imipramine and Paroxetine in the Treatment of Bipolar Depression

Cited by 356 publications

References 32 publications

Transition to Mania During Treatment of Bipolar Depression

Transition to Mania During Treatment of Bipolar Depression

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Neurobiologia do transtorno de humor bipolar e tomada de decisão na abordagem psicofarmacológica

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