Lithium Carbonate and Imipramine in Prevention of Affective Episodes

Prien, Robert F.

doi:10.1001/archpsyc.1973.04200030104017

Cited by 426 publications

(160 citation statements)

References 18 publications

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“…Second, and relatedly, the proportion of placebo-treated patients relapsing with depression in this study (28.3%) was apparently lower than in previous double-blind, placebocontrolled, parallel design studies of lithium (approximately 44-50%) (Fieve et al, 1976;Prien and Klett, 1973b). Unlike the earlier lithium studies that abruptly discontinued lithium from stably maintained patients at the point of randomization, patients taking lithium in the open phase of this study were tapered off over a 2-week period, possibly reducing withdrawal-related relapse rates .…”

Section: Discussioncontrasting

confidence: 66%

Maintenance Efficacy of Divalproex in the Prevention of Bipolar Depression

Gyulai

Bowden

McElroy

et al. 2003

Neuropsychopharmacol

143

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Breakthrough depression is a common problem in the treatment of bipolar disorder. Only one, recently published, double-blind, placebo-controlled trial has examined the efficacy of divalproex in the prevention of depressive episodes in bipolar patients. This report describes, in further detail, the findings from that trial of the effect of divalproex on multiple dimensions of depressive morbidity in bipolar disorder. A randomized, double-blind, parallel-group, multicenter study was conducted over a 52-week maintenance period. Bipolar I patients, who may have been treated with open-label lithium or divalproex and who met recovery criteria within 3 months of onset of an index manic episode, were randomized to maintenance treatment with divalproex, lithium, or placebo in a 2 : 1 : 1 ratio. Adjunctive paroxetine or sertraline for breakthrough depression was allowed in maintenance phase. Outcome measures were the rate of early discontinuation for depression, time to depressive relapse, proportion of patients with depressive relapse, mean change in Depressive Syndrome Scale score, proportion of patients receiving antidepressants, and time in the study. Among patients taking an antidepressant, a higher percentage of patients on placebo than divalproex discontinued early for depression. Patients who were previously hospitalized for affective episodes or took divalproex in the open period relapsed later on divalproex than on lithium during the maintenance period. Divalproex-treated patients had less worsening of depressive symptoms than lithium-treated patients during maintenance. Indices of severity of prestudy illness course predicted worse outcome in all treatment groups. Divalproex improved several dimensions of depressive morbidity and reduced the probability of depressive relapse in bipolar disorder, particularly in patients who had responded to divalproex when manic, and among patients with a more severe course of illness.

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Section: Discussioncontrasting

confidence: 66%

Maintenance Efficacy of Divalproex in the Prevention of Bipolar Depression

Gyulai

Bowden

McElroy

et al. 2003

Neuropsychopharmacol

143

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“…Tricyclic antidepressant mono or adjunctive maintenance therapy is not recommended due to an increased risk of manic switch (level 2 negative)398, 399, 400 (Table 18). …”

Section: Maintenance Therapy For Bipolar Disordermentioning

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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“…In the prophylaxis of unipolar depression, lithium was better than placebo in most studies (Prien et al 1973b;Fieve et al 1975Fieve et al ,1976Kane et al 1982;Glen et al 1984). The only large double-blind controlled study that included a control group on antidepressants found that lithium was better than placebo, but not as effective as antidepressants, and that combination treatment did not result in additional benefits after a 2-year period (Prien et al 1984).…”

Section: Unipolar Depressionmentioning

confidence: 99%