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From the New England Journal of Medicine today--

Antidepressants don't help bipolar patients, study finds

Combined with a mood stabilizer, as many doctors prescribe, the drugs are found to have no effect on depressive symptoms.

By Denise Gellene, Times Staff Writer

March 29, 2007

Antidepressants, which are widely prescribed with mood stabilizers to treat patients with bipolar disorder, do not work in relieving the depressive symptoms of the illness, a large federal study reported Wednesday.

Fore rest of study see: http://www.latimes.com/features/health/med...health-medicine

(Can't post all of story--copyright rules and all that--sorry--)

Personally, the AD's keep me from throwing myself off a bridge fairly often--but then, maybe I'm not BP--they don't exactly say what their def. of BP (or which type) they studied--

china

*

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From the New England Journal of Medicine today--

Antidepressants don't help bipolar patients, study finds

Combined with a mood stabilizer, as many doctors prescribe, the drugs are found to have no effect on depressive symptoms.

*snip*

The difference between the groups was not statistically significant, researchers said.

*snip*

Belmaker noted that two European reviews of published studies found antidepressants to be effective, and that in his own practice he prescribed antidepressants to patients with severe depression but mild mania.

*snip*

He said that bipolar disorder showed wide variability in symptoms, which argued for flexibility in treatment.

First things are good, then they're bad, then they're good...

I say that reading studies is bad for my mental health...

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The following was also in the Wall Street Journal today regarding the same research:

Antidepressants frequently prescribed to help treat bipolar depression do little to help patients recover, according to a new study that adds fuel to a long-running debate over how to best treat an affliction that affects an estimated eight million Americans.

Bipolar disorder, also known as manic depression, is a serious mental illness that involves dramatic swings in mood, including frequent and lengthy periods of depression. Along with mood- stabilizing drugs like lithium, many physicians also treat the disorder with common antidepressants like bupropion, originally branded as Wellbutrin, and paroxetine, better known as Paxil, although such drugs aren't formally approved for this use.

The study could help curb use of antidepressants, but even advocates of less use said they didn't expect any near-term falloff because patients demand the drugs and primary-care doctors often don't know when they are dealing with the condition or other mental illness.

The study, one of the largest of its kind, looked at 366 bipolar- disorder patients who received 26 weeks of treatment in 22 locales. About half the patients got one of several long-established, mood- stabilizing drugs along with either bupropion or paroxetine. The rest received a mood stabilizer and a placebo.

The study, sponsored by the National Institute of Mental Health and published in this week's New England Journal of Medicine, found no statistically significant differences in results between the two groups although, by some measures, the placebo group faired modestly better. About 27.3% of placebo patients had "durable recoveries," or eight consecutive weeks with a normal, reasonably positive mood. Among those taking antidepressants, only 23.5% had durable recoveries.

Some clinicians have long maintained that antidepressants can trigger outbreaks of mania, or extremely elevated mood, in patients with bipolar disorder although research in that area has been sketchy. The study showed little related difference between the two groups in terms of such episodes.

"I think our findings suggest that there is no reason to give the standard antidepressants as the standard treatment," said Gary Sachs, lead researcher and director of the Bipolar Clinic and Research Program at circlei3.gifMassachusetts General Hospital in Boston.

Other researchers not involved said they don't expect the study to immediately prompt doctors and psychiatrists to stop prescribing antidepressants to their bipolar patients. "I think it's going to take more time," said S. Nassir Ghaemi, director of the Bipolar Disorder Research Program at circlei3.gifEmory University, in Atlanta, whose own research indicates that about 80% of all bipolar patients receive antidepressants.

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It's pretty well accepted by now that bp can be divided into subtypes according to both length of cycle and severity of symptom, and the subtypes respond differently to medications. The study apparently does not differentiate.

As stated, many people in the study had comorbid conditions.

Was there standardization of what mood stabilizers people were on? For it to be scientific, all participants would have had to have been on the same one.

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Wellbutrin and Paxil didn't work for me either - but Lexapro does. Actually, Wellbutrin had me so worked up I was going to cut parts of my body off and take them to my therapist, who I was a little ticked off at during that time.

I don't see how you can extrapolate that study to all anti-depressants. But then, I'm not a doctor so what the hell do I know?

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Who knows! It's just like chocolate and wine and microwaves. First they cause cancer then they stop it then they help your heart, then they stress out your immune system, etc etc As someone else said, the key is that YMMV, in fact your mileage WILL vary. Just my two cents

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From the New England Journal of Medicine today--

Antidepressants don't help bipolar patients, study finds

Combined with a mood stabilizer, as many doctors prescribe, the drugs are found to have no effect on depressive symptoms.

By Denise Gellene, Times Staff Writer

March 29, 2007

Antidepressants, which are widely prescribed with mood stabilizers to treat patients with bipolar disorder, do not work in relieving the depressive symptoms of the illness, a large federal study reported Wednesday.

Fore rest of study see: http://www.latimes.com/features/health/med...health-medicine

(Can't post all of story--copyright rules and all that--sorry--)

Personally, the AD's keep me from throwing myself off a bridge fairly often--but then, maybe I'm not BP--they don't exactly say what their def. of BP (or which type) they studied--

china

*

I think the article is hogwash, because Celexa has clearly helped me. You couldn't imagine the relief I felt hours after taking my first dose.

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I'd imagine it's mostly bad news for the makers of wellbutrin (which made me pretty crazy, personally) and paxil (which is actually the only one I've never taken, I think). Didn't they both go generic pretty recently, btw?

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i'm right there with VE that you need standardization in any scientific study, from what kind of patients you are looking at to what drugs and at what doses they are taking. even drug company studies, notorious for being biased, seem to be more on as far as this is concerned.

i can say that wellbutrin helps me, and i'm BP1 w/rapid cycling with PTSD and ADD. that's just me and my particular body chemistry.

and what's bad for you today will be tomorrow's miracle cure. red wine now saves the day, whereas before alcohol was bad for you. next vodka in large quantities will be good for you (look at those robust russians! lol).

i've taken WB and paxil, and especially the paxil seem to be miracles for me. the only thing wrong with paxil is the orgasm thing. otherwise, it is a blessing. WB works nearly as well and doesn't have the bad side effect, so i take it. but both work great.

studies like this get hyped and scare people unnecessarily. we need to focus on controlled science and not just research done to get money for more research that keeps scientists' names out there and keeps their organizations in the spotlight. ask herrfous about that...(about orgs wanting to keep in the spotlight and bogus research, he's a biologist...)

loon

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I've been on the "business end" of a whole shitpile of pharm studies, and this one reads pretty sloppy to me. I wish I could see the actual stats and results. How can you look at one group, on TWO AD, and exterpolate from that --all AD's are useless with all BP?

I think what this will do is affect a whole lot of people who don't see thier docs real often, and who basically will just stop the AD's, cold turkey--which as most of us now, is BAD BAD BAD. Thats what pissses me off about reading shit like this--I have a pretty heavy background in reseach, and it doesn't mean shit to me. Whats it gonna mean to someone who has NO background in research, or drugs, or even what their own dx. is?

I think publishing something like this in the popular press/newspaper is completely irresponsible and potentially dangerous--but of course, no one will accept the blame for some batshit fool going more batshit, or even offing him/herself because they stopped the AD's that might have actually been helping them. I mean, whats one more crazy person, more or less? No one wants to be responsible, no one wants to stand up and face his/her boss and say, "NO, publishing this piece of incomplete trash is WRONG and people may be hurt by this." We all just sit there, and do our jobs and are thankful we have jobs, and can't take the time or have the courage to worry about the guy sitting across from us on the frickin bus who just stopped his AD's cause the paper said he didn't need them. And if he's not there next week, cause he's offed himself, we will never know, or care.

THIS IS BULLSHIT AND ITS WRONG

china, almost glad she doesn't have a job so she doesn't have to confront ANY ethical issues at all

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I think andrewkewlkid hit his head on a nail. More to the point, I think that most serious docs who really follow research veiw this report within the context of the body of literature on bipolar treatment and their own experience. I think most bipolars spend a lot of time depressed no matter what but ADs can decrease depression in enough patients by enough degrees to make them worth prescribing. It would be very easy to argue that mood stabilizers do a poor job of treating depression in bipolars. The study found what it found. The pill that's hard to swallow is that we stay some degree of sick no matter what we take which is why we keep switching meds year after year.

Red wine and dark chocolate, right ;)

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It's pretty well accepted by now that bp can be divided into subtypes according to both length of cycle and severity of symptom, and the subtypes respond differently to medications. The study apparently does not differentiate.

The study did differentiate between BP I and BP II. The full text is available at: http://content.nejm.org/cgi/content/full/NEJMoa064135 . Apparently, the BP II folks did slightly, but not quite significantly worse on AD+mood-stabilizer than placebo+mood-stabilizer, while the outcomes for BP I people were completely statistically indistinguishable.

As stated, many people in the study had comorbid conditions. Was there standardization of what mood stabilizers people were on? For it to be scientific, all participants would have had to have been on the same one.

I agree with you in terms of pure experimental validity. But I think the point of the study was to look at a non-experimental population. Out here, most of us do have co-morbid conditions, on a variety of mood stabilizers, and still depressed. So it seems incredibly relevant to be trying to identify the average true-population treatment effect of AD therapy. That being said, I think that the sample size might have been too small given the tremendous heterogeneity. This would lead to under-powered results, i.e. a failure to find significant differences in outcomes by treatment, and so could be driving the non-results.

I think that the results of the study are actually quite likely true. If we take a BPer and give them just one randomly-chosen antidepressant some might get better, while others clearly do worse. On average there will be no positive effect, as found by Sachs et al. I think what the study misses is the process of search for the "right" antidepressant. E.g., doing horribly on Prozac, but improving on Celexa. With repeated reassignment after failures or deterioration (like in the STAR*D trial) the results might be quite different.

It's the second feature of the study that I think is even more interesting. Specifically, while the raw numbers might hint at it, there doesn't seem to be a statistically significant deterioriation in mood stability in the AD group. This could be again an issue of the sample being underpowered. But if we take it on its face, this implies that there is no reason for doctors to be pulling their patients off of their antidepressants. If anything, it should encourage the doctrinal "ADs make you worse" docs to be willing to let their patients undergo AD trials. The problem is that I feel like this is getting a little less play from the media, and has a strong possibility of being overlooked by the AD-wary docs.

Just my random thoughts,

cache-monkey

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