Furious Seasons

March 29, 2007

Anti-Depressants Nuked By Placebo In Bipolar Disorder

News of a yet-to-be-released study came out yesterday asserting that anti-depressants offer no advantage to patients with bipolar disorder who are already taking a mood stabilizer such as Lithium. In fact, the anti-depressant used performed worse than a mood stabilizer plus a placebo. The full study, which is NIMH-sponsored and sounds to be another round of STEP-BD study, will be released next week.

By the numbers, 23.5 percent of patients taking anti-depressants stayed well for at least 8 weeks versus 27.3 percent of those taking a placebo. This news created a bull market on Wall Street for sugar pills (j/k). Actually, it is startling that placebo beat anti-depressants by so much. What's also interesting is that that 23.5 percent figure isn't too far off the roughly 30 percent of patients with depression in the separate STAR*D study who saw a benefit from an anti-depressant.

It's amusing to me that researchers have finally come to this conclusion after 15 years or more of using anti-depressants as add-on treatments for bipolar disorder and seeing very poor results with patients including the inducement of mania and little relief for the depressive side of things. Does this throw the bipolar treatment game squarely back on mood stabilizers alone? Hopefully. Although I wouldn't be surprised if researchers started pressing for a mood stabilizer plus atypical antipsychotics for bipolars with nasty depression. As long as antipsychotics are only used short-term (an old-fashioned approach), then I have no objection. But if researchers begin pushing for long-term use of atypicals, then we are going to have a problem. The evidence is not there for the atypicals' safety used long-term or for their ability to prevent future episodes of depression.

Basically, depression in bipolar disorder is going to be something patients are going to have to find a way to address on their own. Which is good. I suppose the pharma companies aren't going to be very happy with this news since a good chunk of the $19 billion market for anti-depressants comes from bipolars.

I'll have more on this study next week.

Posted by Philip Dawdy at March 29, 2007 08:27 AM

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Comments

"Basically, depression in bipolar disorder is going to be something patients are going to have to find a way to address on their own."

Precisely what it took me 13 years to discover. After trying virtually every anti-depressant on the market, and even one on the European market--had it shipped to me--I gave up on anti-depressants. But not before I discovered that neurofeedback relieved me of depression. Once doing neurofeedback training for just a few weeks, I was off my anti-depressant and free of the depression that haunted me my whole life. I still have bad days, but the dark long term depressions are gone. Neurofeedback has helped tremendously as has dietary and lifestyle changes. My attitude has changed too...I don't expect to be happy all the time....it's amazing how freeing that alone can be. It's okay to not feel good sometimes! It's normal in fact.

Posted by: Gianna at March 29, 2007 09:08 AM

Wow...I went through the same such issues many years when initially diagnosed. When I did finally see a psychiatrist and was diagnosed properly, I was told that anti-depressants often are completely useless in bipolar disorder and can sometimes make the symptoms worse. Though she was correct on that issue, her solution was excessive dosing of anti-psychotics. I think I would have preferred the anti-depressants.

The point of this is that I was told this bit of information by a medical professional in 2003 so the literature has been out there for a while.

Posted by: Angie at March 29, 2007 10:36 AM

You are right on the mark. The drug companies must be devestated by this study. It was published in this week's New England Journal of Medicine.

The pharma's will have their spin doctors out in full force disputing the study results.

www.MyDepressionSpace.com

Posted by: Charles Donovan at March 29, 2007 05:26 PM