Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabiliser <i>v.</i> mood stabiliser alone

Tohen, Mauricio; Chengappa, K. N. Roy; Suppes, Trisha; Baker, Robert W.; Zarate, Carlos A.; Bowden, Charles L.; Sachs, Gary S.; Kupfer, David J.; Ghaemi, S. Nassir; Feldman, Peter D.; Evans, Angela R.; Calabrese, Joseph R.

doi:10.1192/bjp.184.4.337

Cited by 270 publications

(163 citation statements)

References 25 publications

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“…After screening, 226 publications were identified through the combined search strategies, and we identified 21 trials, with a combined total of 5364 participants that fulfilled the inclusion criteria (Bowden et al 2000bCalabrese et al 2000Calabrese et al , 2003Calabrese et al , 2005Greil et al 1997 ;Hartong et al 2003 ;Keck et al 2007 ;Macfadden et al 2009 ;McElroy et al 2008 ;Quiroz et al 2010 ;Suppes et al 2009 ;Tohen et al 2003Tohen et al , 2004Tohen et al , 2005Tohen et al , 2006Vieta et al 2008a, b ;Young et al 2008 ;Zarate & Tohen, 2004). Table 1 shows details of all trials included in the analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The length of follow-up was 26 wk in three studies Calabrese et al 2000 ;Zarate & Tohen, 2004), between 47 and 52 wk in eight studies (Bowden et al 2000b ;Macfadden et al 2009 ;McElroy et al 2008 ;Tohen et al 2003Tohen et al , 2005Tohen et al , 2006Vieta et al 2008a ;Young et al 2008), between 72 and 80 wk in four studies Calabrese et al 2003Calabrese et al , 2005Tohen et al 2004) and between 100 and 130 wk in six studies (Greil et al 1997 ;Hartong et al 2003 ;Keck et al 2007 ;Quiroz et al 2010 ;Suppes et al 2009 ;Vieta et al 2008b). Median follow-up among the 21 studies was 52 wk, and mean follow-up was 68 wk.…”

Section: Resultsmentioning

confidence: 99%

“…The overall estimate of the RR of depressive relapse for combination therapy compared to comparator [lithium (Vieta et al 2008a) ; lithium/divalproex (Suppes et al 2009 ;Tohen et al 2004 ;Vieta et al 2008b) ; mood stabilizer (Macfadden et al 2009 ;Zarate & Tohen, 2004)] was 0.48 (95 % CI 0.35-0.64, p<0.001) (Fig. 3b).…”

Section: Rr For Depressive Relapsementioning

confidence: 99%

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Effectiveness of psychotropic medications in the maintenance phase of bipolar disorder: a meta-analysis of randomized controlled trials

Vieta

Günther²,

Locklear

et al. 2011

Int. J. Neuropsychopharm.

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The purpose of this meta-analysis was to examine the efficacy of maintenance treatments for bipolar disorder. Placebo-controlled or active comparator bipolar maintenance clinical trials of o6 months' duration with at least 15 patients/treatment group were identified using Medline, EMBASE, clinicaltrials.gov, and Cochrane databases (1993 to July 2010). The main outcome measure was relative risk for relapse for patients in remission. Twenty trials (5364 patients) were identified. Overall, lithium and quetiapine were the most studied agents (eight and five trials, respectively). The majority of studies included patients who had previously responded to treatment for an acute episode. All interventions, with the exception of perphenazine+mood stabilizer, showed a relative risk for manic/mixed or depressive relapse below 1.0, although there was variation in the statistical significance of the findings vs. placebo. No monotherapy was associated with a significantly reduced risk for both manic/mixed and depressed relapse. Of the combination treatments, only quetiapine+lithium/divalproex, was associated with a significantly reduced risk vs. comparator (placebo+lithium/valproate) for relapse at both the manic/mixed and depressed poles of bipolar illness. Limitations for the analysis include differences in study durations and definitions of relapse. In conclusion, available maintenance therapies show considerable variation in efficacy. The efficacy of lithium and divalproex has been confirmed, but newer therapies, such as a number of atypical antipsychotics were also shown to be effective in bipolar disorder. Efficacy of all maintenance interventions needs to be balanced against the safety and tolerability profiles of individual agents.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effectiveness of psychotropic medications in the maintenance phase of bipolar disorder: a meta-analysis of randomized controlled trials

Vieta

Günther²,

Locklear

et al. 2011

Int. J. Neuropsychopharm.

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“…Over the last decade, only three controlled trials of combination maintenance treatment of bipolar disorder have been published. [52][53][54] In the only large-scale controlled study, olanzapine plus lithium or valproate was compared to lithium or valproate alone over 18 months in 99 patients who had responded to the combination for acute mania. 52 Dropout rates were very high; 69% of those on combination and 90% of those on lithium or valproate alone discontinued the study, with the majority of dropouts occurring for reasons other than relapse.…”

Section: Combination Treatmentsmentioning

confidence: 99%

“…[52][53][54] In the only large-scale controlled study, olanzapine plus lithium or valproate was compared to lithium or valproate alone over 18 months in 99 patients who had responded to the combination for acute mania. 52 Dropout rates were very high; 69% of those on combination and 90% of those on lithium or valproate alone discontinued the study, with the majority of dropouts occurring for reasons other than relapse. Modest additional significant efficacy was seen with the combination as measured by median time to symptomatic relapse (as measured by rating scale scores) P = 0.023, but not by syndromal relapse rates (29 vs 31%) or time to syndromal relapse.…”

Section: Combination Treatmentsmentioning

confidence: 99%

Treatment-resistant bipolar disorder

2006

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Despite the remarkable increase in medications validated as effective in bipolar disorder, treatment is still plagued by inadequate response in acute manic or depressive episodes or in long-term preventive maintenance treatment. Established first-line treatments include lithium, valproate and second-generation antipsychotics (SGAs) in acute mania, and lithium and valproate as maintenance treatments. Recently validated treatments include extended release carbamazapine for acute mania and lamotrigine, olanzapine and aripiprazole as maintenance treatments. For treatment-resistant mania and as maintenance treatments, a number of newer anticonvulsants, and one older one, phenytoin, have shown some promise as effective. However, not all anticonvulsants are effective and each agent needs to be evaluated individually. Combining multiple agents is the most commonly used clinical strategy for treatment resistant bipolar patients despite a relative lack of data supporting its use, except for acute mania (for which lithium or valproate plus an SGA is optimal treatment). Other approaches that may be effective for treatment-resistant patients include high-dose thyroid augmentation, clozapine, calcium channel blockers and electroconvulsive therapy (ECT). Adjunctive psychotherapies show convincing efficacy using a variety of different techniques, most of which include substantial attention to education and enhancing coping strategies. Only recently, bipolar depression has become a topic of serious inquiry with the dominant controversy focusing on the place of antidepressants in the treatment of bipolar depression. Other than mood stabilizers alone or the combination of mood stabilizers and antidepressants, most of the approaches for treatment-resistant bipolar depression are relatively similar to those used in unipolar depression, with the possible exception of a more prominent place for SGAs, prescribed either alone or in combination with antidepressants. Future work in the area needs to explore the treatments commonly used by clinicians with inadequate research support, such as combination therapy and the use of antidepressants as both acute and adjunctive maintenance treatments for bipolar disorder. With the first report of lithium's efficacy in 1949 by Cade, bipolar disorder has the longest record of treatment efficacy among the major Axis I disorders. Furthermore, after more than half a century of clinical research, multiple agents from many different pharmacological classes have shown at least some efficacy, while many other agents (albeit without a consistent database demonstrating their utility) are prescribed regularly by clinicians. Yet, despite this plethora of choices, treatment of bipolar disorder remains suboptimal from the points of view of clinicians and patients alike. Whether measured by recovery time from manic or depressive episodes or preventive efficacy of maintenance treatments, bipolar disorder is characterized by sluggish responses, inadequate responses, poor compliance and recurrences in controlled cli...

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Prevalence and Characteristics of Undiagnosed Bipolar Disorders in Patients With a Major Depressive Episode

Angst

Azorin

Bowden³

et al. 2011

Arch Gen Psychiatry

369

265

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The bipolar-specifier criteria in comparison with DSM-IV-TR criteria were valid and identified an additional 31% of patients with major depressive episodes who scored positive on the bipolarity criteria. Family history, illness course, and clinical status, in addition to DSM-IV-TR criteria, may provide useful information for physicians when assessing evidence of bipolarity in patients with major depressive episodes. Such an assessment is recommended before deciding on treatment.

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Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone

Abstract: Patients taking olanzapine added to lithium or valproate experienced sustained symptomatic remission, but not syndromic remission, for longer than those receiving lithium or valproate monotherapy.

Cited by 270 publications

References 25 publications

Effectiveness of psychotropic medications in the maintenance phase of bipolar disorder: a meta-analysis of randomized controlled trials

Effectiveness of psychotropic medications in the maintenance phase of bipolar disorder: a meta-analysis of randomized controlled trials

Treatment-resistant bipolar disorder

Prevalence and Characteristics of Undiagnosed Bipolar Disorders in Patients With a Major Depressive Episode

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