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Titolo:
Bipolar rapid cycling: Focus on depression as its hallmark
Autore:
Calabrese, JR; Shelton, MD; Bowden, CL; Rapport, DJ; Suppes, T; Shirley, ER; Kimmel, SE; Caban, SJ;
Indirizzi:
Univ Hosp Cleveland, Dept Psychiat, Cleveland, OH 44106 USA Univ Hosp Cleveland Cleveland OH USA 44106 chiat, Cleveland, OH 44106 USA Case Western Reserve Univ, Sch Med, Cleveland, OH USA Case Western ReserveUniv Cleveland OH USA v, Sch Med, Cleveland, OH USA Univ Texas, Hlth Sci Ctr, San Antonio, TX USA Univ Texas San Antonio TX USA v Texas, Hlth Sci Ctr, San Antonio, TX USA Univ Texas, Sw Hlth Sci Ctr, Dallas, TX 75230 USA Univ Texas Dallas TX USA 75230 xas, Sw Hlth Sci Ctr, Dallas, TX 75230 USA
Titolo Testata:
JOURNAL OF CLINICAL PSYCHIATRY
, volume: 62, anno: 2001, supplemento:, 14
pagine: 34 - 41
SICI:
0160-6689(2001)62:<34:BRCFOD>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
AFFECTIVE-DISORDER; INDUCED MANIA; DOUBLE-BLIND; LAMOTRIGINE; LITHIUM; CARBAMAZEPINE; PROPHYLAXIS; VALIDITY; EFFICACY; MONOTHERAPY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Social & Behavioral Sciences
Clinical Medicine
Citazioni:
37
Recensione:
Indirizzi per estratti:
Indirizzo: Calabrese, JR Mood Disorders Program, 11400 Euclid Ave,Suite 200, Cleveland, OH 44106 USA Mood Disorders Program 11400 Euclid Ave,Suite 200 ClevelandOH USA 44106
Citazione:
J.R. Calabrese et al., "Bipolar rapid cycling: Focus on depression as its hallmark", J CLIN PSY, 62, 2001, pp. 34-41

Abstract

The phenomenon of frequent cycling in bipolar disorder was first recognized by Emil Kraepelin in 1913. More recently, rapid cycling has been reportedto be a predictor of nonresponse to treatment. At the time of presentation, most patients with DSM-IV-defined rapid cycling appear to be in the depressed phase of their illness. Frequent and more severe episodes of depression appear to be the hallmark of rapid cycling. Reported in this article are recent preliminary data suggesting that the combination of lithium and divalproex sodium administered continuously over 6 months appears to result in marked acute and continuation antimanic efficacy in 85% of patients and marked antidepressant efficacy in 60%. However, only one half of patients experienced bimodal stabilization. Comorbid alcohol, cannabis, and/or cocaine abuse and/or dependence did not appear to directly affect the spectrum of efficacy of lithium and divalproex or response rates in compliant patients. Comorbidity appeared to alter prognosis by increasing the prevalence of poorcompliance. The majority of patients receiving lithium and divalproex who required additional treatment were depressed, suggesting that the frequent recurrence of depression is the primary unmet need in patients with rapid cycling. The use of antidepressants in this population has been discouraged because of concerns about the possibility of cycle acceleration. There exists a need for a pharmacotherapy that not only possesses marked acute antidepressant properties, but that does so without inducing switching or cycle acceleration. A double-blind, placebo-controlled trial of lamotrigine monotherapy in bipolar I depression has demonstrated efficacy without causing switching at a rate exceeding placebo: however, this initial study excluded patients with rapid cycling. To explore the efficacy of lamotrigine in rapid cycling, a recent multicenter study has examined lamotrigine as a maintenance therapy for this population. The results indicate that lamotrigine may be a useful treatment for patients with rapid-cycling bipolar II disorder and that this drug has begun to address this unmet need.

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Documento generato il 03/07/20 alle ore 15:56:35