Gabapentin augmentation therapy in bipolar depression

Wang, Po; Santosa, Claudia; Schumacher, Matthew; Winsberg, Mirène E.; Strong, Connie M.; Ketter, Terence A.

doi:10.1034/j.1399-5618.2002.01211.x

Cited by 57 publications

(28 citation statements)

References 40 publications

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“…Placebo-controlled data concerning the acute phase are negative (Frye et al, 2000) and gabapentin can be considered only as an add-on therapy (Pande et al, 2000;Vieta et al, 2006a;Wang et al, 2002). It also might be a useful agent for the treatment of anxiety disorders that commonly accompany bipolar illness and could substitute for bendodiazepines.…”

Section: Gabapentinmentioning

confidence: 99%

Treatment of bipolar disorder: a systematic review of available data and clinical perspectives

Fountoulakis¹,

Vieta²

2008

Int. J. Neuropsychopharm.

154

105

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This paper is a systematic review of the available data concerning the treatment of bipolar disorder: a systematic Medline search concerning treatment guidelines and clinical trials. The search for treatment guidelines returned 583 articles and 913 papers for RCTs. The search was last performed on 1 March 2008. An additional search included repositories of clinical trials and previous systematic reviews in order to trace especially older trials. The literature suggests that lithium is useful during the acute manic and the maintenance phase. Both first- and second-generation antipsychotics are efficacious in the treatment of acute mania. Quetiapine and the olanzapine-fluoxetine combination are also effective for treating bipolar depression, while olanzapine, quetiapine and aripiprazole are effective during the maintenance phase. Anticonvulsants, particularly valproate and carbamazepine have antimanic properties, whereas lamotrigine may be preferably effective in the treatment of depression but not mania. Antidepressants should always be used in combination with an antimanic agent because they were reported to induce switching to mania or hypomania, mixed episodes, and rapid cycling when given as monotherapy. The best evidence-based psychosocial interventions for bipolar disorder are group- and family-focused psychoeducation. Electroconvulsive therapy is an option for refractory patients. Although a variety of treatment options for bipolar disorder is currently available, their effectiveness is far from satisfactory, especially against bipolar depression and maintenance. Combination therapy may improve treatment outcome but it also carries the burden of more side-effects. Further research as well as the development of better guidelines and algorithms for step-by-step rational treatment are necessary.

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Section: Gabapentinmentioning

confidence: 99%

Treatment of bipolar disorder: a systematic review of available data and clinical perspectives

Fountoulakis¹,

Vieta²

2008

Int. J. Neuropsychopharm.

154

105

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“…Early open-label studies in bipolar disorder stirred great interest in gabapentin's potential mood-stabilizing and antidepressant properties (see complete review [232]), but a series of double-blind, placebo-controlled trials did not find the medication effective as monotherapy or add-on therapy for treating acute mania [233,234]. However, an open-label study found adjunctive gabapentin was effective and well-tolerated in patients with mild to moderate bipolar depression [235] and a recent small, randomized clinical trial comparing the prophylactic efficacy of adjunctive gabapentin to placebo suggests that, despite lack of acute efficacy, treatment with gabapentin might provide some benefit on the long-term outcome of bipolar disorder [236]. To our knowledge, no study has been done to directly examine the effectiveness of gabapentin in the treatment of MDD.…”

Section: Evidence Of Antidepressant Efficacy Associated With Gabaergimentioning

confidence: 99%

GABAergic Contributions to the Pathophysiology of Depression and the Mechanism of Antidepressant Action

Sanacora

Sarıçiçek²

2007

CNSNDDT

117

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Increasing evidence suggests that abnormalities in amino neurotransmission are associated with the neurobiology of depression. Preclinical studies demonstrate that GABA modulating agents are active in commonly used rodent behavioral models of antidepressant activity, and that chronic administration of antidepressant drugs induces marked changes in GABAergic function. In humans, depressed patients have lower plasma, CSF and brain GABA concentrations than non-depressed comparison subjects. The recent discovery that several anticonvulsant and GABA-mimetic agents possess mood stabilizing and antidepressant properties has further increased interest in these findings. This review outlines the existing literature investigating the possible involvement of GABA in the neurobiology of depression and briefly highlights how this information may afford new targets for antidepressant drug development.

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“…Clinically, gabapentin is indicated as an add-on medication for the treatment of partial seizures (2) and neuropathic pain (3). It was also claimed to be beneficial in several other clinical disorders such as anxiety (4), bipolar disorder (5), and hot flashes (6).…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of the Antinociceptive Action of Gabapentin

2006

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Abstract. Gabapentin, a γ-aminobutyric acid (GABA) analogue anticonvulsant, is also an effective analgesic agent in neuropathic and inflammatory, but not acute, pain systemically and intrathecally. Other clinical indications such as anxiety, bipolar disorder, and hot flashes have also been proposed. Since gabapentin was developed, several hypotheses had been proposed for its action mechanisms. They include selectively activating the heterodimeric GABA B receptors consisting of GABA B1a and GABA B2 subunits, selectively enhancing the NMDA current at GABAergic interneurons, or blocking AMPA-receptor-mediated transmission in the spinal cord, binding to the L-α-amino acid transporter, activating ATP-sensitive K + channels, activating hyperpolarization-activated cation channels, and modulating Ca 2+ current by selectively binding to the specific binding site of [3 H]gabapentin, the α 2 δ subunit of voltage-dependent Ca 2+ channels. Different mechanisms might be involved in different therapeutic actions of gabapentin. In this review, we summarized the recent progress in the findings proposed for the antinociceptive action mechanisms of gabapentin and suggest that the α 2 δ subunit of spinal N-type Ca 2+ channels is very likely the analgesic action target of gabapentin.

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Gabapentin augmentation therapy in bipolar depression

Abstract: Open adjunctive GBP was effective and well tolerated in patients with mild to moderate bipolar depression. This open pilot study must be viewed with caution, and randomized controlled studies are warranted.

Cited by 57 publications

References 40 publications

Treatment of bipolar disorder: a systematic review of available data and clinical perspectives

Treatment of bipolar disorder: a systematic review of available data and clinical perspectives

GABAergic Contributions to the Pathophysiology of Depression and the Mechanism of Antidepressant Action

Mechanisms of the Antinociceptive Action of Gabapentin

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