Original Article
Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression
N Engl J Med 2007; 356:1711-1722April 26, 2007
- Abstract
Background
Episodes of depression are the most frequent cause of disability among patients with bipolar disorder. The effectiveness and safety of standard antidepressant agents for depressive episodes associated with bipolar disorder (bipolar depression) have not been well studied. Our study was designed to determine whether adjunctive antidepressant therapy reduces symptoms of bipolar depression without increasing the risk of mania.
Methods
In this double-blind, placebo-controlled study, we randomly assigned subjects with bipolar depression to receive up to 26 weeks of treatment with a mood stabilizer plus adjunctive antidepressant therapy or a mood stabilizer plus a matching placebo, under conditions generalizable to routine clinical care. A standardized clinical monitoring form adapted from the mood-disorder modules of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, was used at all follow-up visits. The primary outcome was the percentage of subjects in each treatment group meeting the criterion for a durable recovery (8 consecutive weeks of euthymia). Secondary effectiveness outcomes and rates of treatment-emergent affective switch (a switch to mania or hypomania early in the course of treatment) were also examined.
Results
Forty-two of the 179 subjects (23.5%) receiving a mood stabilizer plus adjunctive antidepressant therapy had a durable recovery, as did 51 of the 187 subjects (27.3%) receiving a mood stabilizer plus a matching placebo (P=0.40). Modest nonsignificant trends favoring the group receiving a mood stabilizer plus placebo were observed across the secondary outcomes. Rates of treatment-emergent affective switch were similar in the two groups.
Conclusions
The use of adjunctive, standard antidepressant medication, as compared with the use of mood stabilizers, was not associated with increased efficacy or with increased risk of treatment-emergent affective switch. Longer-term outcome studies are needed to fully assess the benefits and risks of antidepressant therapy for bipolar disorder. (ClinicalTrials.gov number, NCT00012558.)
Media in This Article
Figure 1
Enrollment, Randomization, and Disposition of Subjects.Table 1
Effectiveness Outcomes.Article Activity
- Article
Bipolar disorder, the sixth-leading cause of disability worldwide,1 is a chronic and recurrent psychiatric illness with a lifetime prevalence of just under 4%2 and annual costs that exceed those of diabetes or recurrent (unipolar) major depressive disorder.3 Although abnormal mood elevation is the cardinal diagnostic feature that distinguishes bipolar disorder from recurrent major depressive disorder, depression that alternates with manic episodes (bipolar depression) is the leading cause of impairment and death among patients with bipolar disorders.4-6
Two main limitations related to standard antidepressant medications hamper their use in the treatment of bipolar depression. First, though these agents have proved to be efficacious in treating unipolar depression, the data providing support for their use in treating bipolar depression are minimal and are not considered to be sufficient to guide clinical practice. Second, the widely held belief that antidepressants can induce new episodes of abnormal mood elevation or accelerate the rate of cycling has been neither confirmed nor refuted by placebo-controlled studies.
Adequately powered, well-controlled studies are needed to show the effectiveness of treatments for bipolar depression under conditions of routine clinical practice. Pivotal studies sponsored by pharmaceutical companies are designed primarily to demonstrate efficacy for purposes of regulatory approval. These studies typically involve narrow eligibility requirements and short-term cross-sectional outcomes, which limit the generalizability of the results to routine clinical practice.
The Food and Drug Administration (FDA) has not approved any of the more than 25 standard antidepressants for the treatment of bipolar depression. However, standard antidepressants are commonly used as adjuncts to mood-stabilizing medication for the treatment of bipolar depression, despite limited evidence of the short-term and long-term efficacies and the putative risk of treatment-emergent mania or hypomania.7-10 Furthermore, in a placebo-controlled study in which subjects using therapeutic doses of the mood stabilizer lithium were randomly assigned to receive concurrent treatment with a standard antidepressant (paroxetine or imipramine) or placebo, those receiving lithium plus an antidepressant did not have a significant advantage over those receiving lithium plus placebo.11 Indeed, the only large positive trial of standard antidepressant treatment for bipolar depression published to date involved combination treatment with an atypical antipsychotic drug, rather than a traditional (non–dopamine blocking) mood stabilizer.12 In that study, the combination of olanzapine and fluoxetine was superior to placebo as well as to olanzapine alone. However, the study did not address the effectiveness of standard antidepressants used in conjunction with lithium or valproate; thus, its results may not be generalizable to the treatment of patients with bipolar depression who typically seek treatment.
The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is a collaboration sponsored by the National Institute of Mental Health designed to evaluate the effectiveness of treatments for bipolar disorder and to provide results that are generalizable to routine clinical practice.13 STEP-BD recruited a representative group of patients with bipolar disorder who were seeking treatment and used clinically meaningful outcomes. We report results from a controlled trial within STEP-BD evaluating the effectiveness of standard antidepressants for the short-term treatment of major depressive episodes in patients with bipolar disorder.
Methods
The STEP-BD collaborators conducted this multicenter, double-blind, randomized, placebo-controlled, parallel-group study of standard antidepressants (either bupropion or paroxetine) as adjuncts to treatment with mood stabilizers (lithium, valproate, carbamazepine, or other FDA-approved antimanic agents) at 22 centers in the United States between November 1999 and July 2005. Subjects with bipolar I or bipolar II disorder were treated for up to 26 weeks to evaluate the effectiveness, safety, and tolerability of the adjunctive use of antidepressant medication. The study was approved by the institutional review board at each site and was overseen by a data and safety monitoring board.
The rationale for the design and methods of the STEP-BD trials has been described previously.13 The STEP-BD protocol was critiqued by a committee of external experts and consumer advocates and was posted for public review.
Selection of Subjects
Study subjects were at least 18 years old and met the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), for a major depressive episode associated with bipolar I or bipolar II disorder. The diagnosis of bipolar disorder was confirmed at entry into STEP-BD by using an affective disorder evaluation form adapted from the Structured Clinical Interview for DSM-IV14 and by the independent administration of the Mini-International Neuropsychiatric Interview.15 We excluded subjects with a history of intolerance or nonresponse to both bupropion and paroxetine, as well as those requiring current short-term treatment for a coexisting substance-abuse disorder or requiring the addition of antipsychotic medication or a change in the dose of a long-term antipsychotic medication. Subjects enrolled in STEP-BD provided additional written informed consent for our study. At the time of randomization, all subjects agreed to receive a concomitant mood stabilizer.
Interventions
Subjects were assigned to double-blind treatment with a mood stabilizer plus an adjunctive antidepressant or a mood stabilizer plus a matching placebo with the use of an equipoise-stratified randomization method.16 This method enabled treating psychiatrists to choose from three randomization strata (placebo vs. bupropion, placebo vs. paroxetine, and placebo vs. either antidepressant) and thus allowed for the inclusion of subjects with a clear preference for a given antidepressant. STEP-BD clinicians, trained and certified in the use of a clinical monitoring form and other study scales, selected the mood stabilizers and managed all medications.12
Paroxetine and bupropion were selected to represent the standard antidepressants most commonly prescribed for bipolar depression, since these agents have different mechanisms of action and adverse-effect profiles.9,11,16,17 Use of these antidepressants is associated with low rates of switch to mania or hypomania early in the course of treatment (treatment-emergent affective switch). Mood stabilizers were initially limited to lithium, valproate, the combination of lithium and valproate, or carbamazepine. In 2004, the protocol was amended to define mood stabilizers operationally as any FDA-approved antimanic agent.
Mood-stabilizing medications were adjusted clinically to target the therapeutic range for each drug. Standard antidepressant medications in use at randomization were tapered by at least 50% during the first week after randomization and were not permitted after the second week. All other clinically indicated medications were permitted. Subjects also had the option of remaining with their nonstudy psychotherapist, of having no psychosocial intervention, or of being enrolled into a STEP-BD trial comparing long-term (intensive) psychosocial interventions with a short-term (brief) psychoeducational intervention.18
Paroxetine or matching placebo was initiated at 10 mg daily and increased to a maximum of 40 mg daily. A sustained-release preparation of bupropion or matching placebo was initiated at 150 mg daily and increased to a maximum of 375 mg daily. Four follow-up assessments were scheduled over the first 6 weeks. Subjects who had severe adverse effects or met criteria for hypomania or mania discontinued the antidepressant or placebo and received open treatment while remaining in STEP-BD. After 6 weeks, subjects who had a response continued the double-blind treatment with monthly follow-up for up to 20 more weeks; those who did not were offered further increases in the dose of the antidepressant or placebo or open-label increase in the dose, with follow-up scheduled at 2-week intervals over the next 10 weeks.
Effectiveness Outcomes
At study entry, subjects were assessed with the use of the Clinical Monitoring Form for mood disorders19 and formal mood-rating scales. The Clinical Monitoring Form is a composite assessment tool developed for use in clinical practice; it includes a version of the current mood modules of the Structured Clinical Interview for DSM-IV, modified to include continuous symptom subscales for depression (SUM-D) and mood elevation (SUM-ME), in addition to questions about categorical outcomes. SUM-D scores range from 0 to 22 and SUM-ME scores range from 0 to 16; higher scores indicate more severe symptoms. The SUM-D and SUM-ME subscales are well correlated with formal rating scales: the Montgomery–Asberg Depression Rating Scale and the Young Mania Rating Scale, respectively.19 The formal rating scales were administered by independent raters at study entry and also quarterly, for quality control. The Clinical Monitoring Form was administered at every follow-up visit.
The a priori primary outcome was durable recovery, defined as euthymia for at least 8 consecutive weeks. Subjects were also classified on the basis of secondary outcomes, defined in Table 1Table 1
Effectiveness Outcomes.. Treatment-effectiveness response rates were based on subjects whose SUM-D scores improved by at least 50% from their baseline scores and who did not meet the DSM-IV criteria for hypomania or mania.Statistical Analysis
Summary statistics for continuous variables are presented as means with standard deviations or medians with interquartile ranges. Summary statistics for discrete variables are presented as percentages. Parametric and nonparametric analysis-of-variance methods and chi-square tests were used to compare the rates of baseline clinical and demographic characteristics, characteristics of the clinical course, side effects, and serious adverse events between the two groups.
Analyses included all subjects who were randomly assigned to a treatment group. Except where noted, analyses are based on the last observation carried forward. Logistic-regression models were used to determine whether there was an independent effect of treatment on outcome rates after adjustment for site and antidepressant preference (none, for paroxetine, or for bupropion). Given the observed rate of recovery of 27.3% among subjects receiving a mood stabilizer plus a matching placebo, the study had a statistical power of 80% to detect an absolute difference of 15% between the two groups in rates of recovery. A P value of 0.05 was considered to indicate statistical significance.
Results
Characteristics and Disposition of Subjects
Figure 1Figure 1
Enrollment, Randomization, and Disposition of Subjects. shows the disposition of study subjects. There were no significant differences in the demographic or clinical characteristics of the two treatment groups at baseline (Table 2Table 2
Baseline Characteristics of Subjects, According to Treatment Group.). Data on the course of treatment are listed in Table 3Table 3
Clinical Course of Study Subjects.. There was no significant difference between the two groups in the mean time in treatment.Treatment Outcomes
Treatment outcomes are defined in Table 1 and summarized in Table 4Table 4
Outcomes According to Treatment Group.. There were no significant differences between the two groups in the percentage of subjects meeting the criteria for any effectiveness outcome. However, modest nonsignificant trends consistently favored treatment with a mood stabilizer plus a matching placebo over treatment with a mood stabilizer plus an adjunctive antidepressant. Similar percentages of subjects in each group did not have even a single week of euthymia over the first 16 weeks and were classified as having no response to an adequate course of treatment.The rates of durable recovery were similar in the two groups among subjects with bipolar I disorder. Among subjects with bipolar II disorder, there was a nonsignificant trend toward a better response in the patients receiving a mood stabilizer plus placebo than in those receiving a mood stabilizer plus an antidepressant. In the group receiving a mood stabilizer and an antidepressant, response rates did not differ significantly between subjects with bipolar I disorder (25.4%) and those with bipolar II disorder (20.4%).
Analysis of results that were adjusted for acceptance or rejection of enrollment into the STEP-BD randomized psychosocial treatment study showed no significant differences between the two groups (adjusted P=0.25 for the primary outcome). The augmentation of drug therapy with brief or intensive psychotherapy carried no significant benefit. For the subgroup of 130 subjects who rejected random assignment to a protocol-specified psychotherapy, rates of recovery were 17.9% (12 of 67 subjects) in the group receiving a mood stabilizer plus an antidepressant and 30.2% (19 of 63 subjects) in the group receiving a mood stabilizer plus placebo (P=0.15); for the subgroup of 106 subjects who underwent brief psychoeducation, 20.0% (11 of 55 subjects) and 19.6% (10 of 51 subjects), respectively (P=0.99); and for the subgroup of 130 subjects who underwent intensive psychotherapy, 33.3% (19 of 57 subjects) and 30.1% (22 of 73 subjects), respectively (P=0.71). Furthermore, there was no significant interaction between the augmentation of drug therapy with psychotherapy and the type of psychosocial intervention used (P=0.28).
Adverse Events
The numbers of subjects with adverse events of more than moderate severity and with serious adverse events are reported in Table 3. The rate of any individual adverse event did not differ significantly between the two groups, and similar percentages of subjects in each group discontinued treatment owing to adverse events. The rate of hospitalization for suicidal ideation was low and was not significantly different between the two groups. Less than 1% of subjects in either group attempted suicide. No patients died.
There was no significant difference in the rates of prospectively observed treatment-emergent mania, hypomania, or mixed episodes between the patients receiving a mood stabilizer plus an antidepressant (10.1%) and those receiving a mood stabilizer plus placebo (10.7%). Among subjects reporting treatment-emergent affective switch associated with one or more previous courses of treatment with antidepressants, response rates did not differ significantly between the group receiving a mood stabilizer plus an antidepressant and the group receiving a mood stabilizer plus placebo (13.6% and 25.4%, respectively; P=0.10), nor did the prospectively observed rates of treatment-emergent affective switch (10.2% and 17.9%, respectively; P=0.22). Among the subjects receiving a mood stabilizer plus an antidepressant, there were no significant differences in the rate of any primary or secondary outcome between subjects receiving bupropion and those receiving paroxetine.
Discussion
This large, randomized, placebo-controlled effectiveness study found no evidence that treatment with a mood stabilizer and an antidepressant confers a benefit over treatment with a mood stabilizer alone. Rates of treatment-emergent mania or hypomania observed prospectively were similar among subjects receiving adjunctive antidepressants and those receiving placebo. Our data suggest that the short-term addition of bupropion or paroxetine to mood-stabilizer therapy does not increase the risk of cycling from depression to mania or hypomania. However, we did not study a “pure” placebo group (one in which no active psychotropic medication was administered) and hence cannot establish the effectiveness of treatment with a mood stabilizer alone.
There were several differences in the design of our study and that of previous studies. We primarily enrolled subjects who were already receiving clinical treatment at participating sites and who continued care with their usual provider. Our eligibility criteria permitted the entry of subjects with bipolar I or bipolar II disorder, including those with coexisting anxiety disorders, substance-abuse disorders, or psychotic symptoms, since epidemiologic evidence shows that most patients with bipolar disorder have such features.20 We also allowed subjects to receive additional pharmacotherapy or psychotherapy. These differences may explain the disparity between our findings and those from the meta-analysis of efficacy studies by Gijsman et al.,21 which found standard antidepressants to be efficacious in the treatment of bipolar depression.
Our study design also differed from that of most efficacy studies in that it featured equipoise-randomization strata. This design allowed the entry of subjects who preferred to avoid one of the standard antidepressants, by eliminating the possibility that the subjects would be randomly assigned to a treatment they did not want to receive. Finally, our a priori, clinically meaningful, primary outcome of durable recovery was met if subjects had euthymia for 8 consecutive weeks. In contrast, most short-term efficacy studies designate as the primary outcome change from the baseline score on symptom-severity scales at a single visit. Our results are therefore likely to be more in accord with the expectations of clinicians and patients in the general population for treatment effectiveness than are the results of previous efficacy studies.
Our study had several limitations. First, since antidepressants are not a homogeneous class, we cannot rule out the possibility that other antidepressant medications may be more efficacious or have a greater propensity to induce manic symptoms than our study medications. Nevertheless, bupropion and paroxetine are two of the most frequently recommended antidepressants for patients with bipolar disorder.22 Some studies suggest that antidepressants vary in their tendency to cause a switch to mania or hypomania, even when used as adjuncts to mood-stabilizing treatments.17,23,24 Notably, the largest of these studies — the double-blind comparison of bupropion, sertraline, and venlafaxine by the Stanley Foundation Bipolar Network — found no difference in efficacy among the treatments but did find a significantly higher rate of switch from depression to mania or hypomania among subjects receiving venlafaxine than among those receiving bupropion or sertraline.9,24 Therefore, although neither paroxetine nor bupropion was associated with an increased rate of treatment-emergent affective switch in our study, other antidepressants may be. Our results are, however, largely in agreement with those from studies that associate selective serotonin-reuptake inhibitors and bupropion with lower rates of treatment-emergent affective switch than venlafaxine or desipramine.17,23
Second, our efficacy and safety findings are based on a relatively brief period of observation. The primary outcome of 8 consecutive weeks of euthymia, however, reflects a considerably longer period than do the cross-sectional outcomes (response or remission) used in typical efficacy studies. Although an 8-week period of recovery may be too brief to be clinically meaningful for patients, an 8-week interval of wellness may be a better predictor of long-term outcome than are scores on cross-sectional rating scales. Effectiveness outcomes such as those used in our study may be more applicable to clinical practice than are short-term cross-sectional outcomes, since the apparent benefit based on cross-sectional outcomes may not be persistent and since nearly all traditional efficacy trials define outcomes on the basis of improvement in depression-rating scores without correction for rates of treatment-emergent affective switch. Results from traditional efficacy studies can thereby misclassify patients with emergent hypomania or mania as having had a response. The Stanley Foundation Bipolar Network, using outcome criteria corrected for rates of treatment-emergent affective switch, reported that 33.3% of patients with bipolar depression had a response to treatment with bupropion, 41.4% had a response to sertraline, and 35.6% had a response to venlafaxine24; these response rates are similar to the treatment-effectiveness response rates reported here.
Third, many of our study subjects received some form of psychosocial intervention. Although the efficacy of psychosocial therapies has not been established for patients with acute bipolar depression,25,26 it is possible that the adjunctive use of psychosocial interventions limits the generalizability of our results or reduced our ability to detect the effects of antidepressant therapy. Psychosocial intervention did not appear to affect the two study groups differently. The two groups had similar percentages of subjects who received psychosocial interventions, and similar response rates were found in the subgroups receiving any form of psychosocial intervention and in the subgroup that declined psychosocial treatment. Results of a longer-term STEP-BD study do provide support for use of the psychosocial interventions used in our study.18
Fourth, some of our findings rely on last-observation-carried-forward analyses. Such analyses generally involve the imputation of data, which raises concern about the degree to which incomplete follow-up influenced the results. However, data imputation was not required for analysis of the primary outcome (durable recovery) or of the majority of secondary outcomes reported in our study. These categorical outcomes represent subjects who actually reached a study-defined outcome. Some data for the change in SUM-D and SUM-ME scores were imputed, but this is unlikely to have influenced our outcomes, as it was required for only about one third of the subjects in each group.
Fifth, patients who had recently had a manic episode were likely to be underrepresented in our study. Clinicians caring for these potential subjects might have judged them to be at high risk for a switch from depression to mania or hypomania and therefore might have avoided enrolling them into our double-blind study that exposed subjects to a standard antidepressant. Thus, our results are likely to be applicable only to those patients with bipolar depression who are considered appropriate candidates for treatment with standard antidepressants.
In summary, for the treatment of bipolar depression, we found that mood-stabilizing monotherapy provides as much benefit as treatment with mood stabilizers combined with a standard antidepressant. There was no significant difference in the adverse effects, including switch to mania, between patients who received adjunctive antidepressants and those that did not. Further research examining the efficacy of different mood stabilizers for bipolar depression may be useful.
Supported by a contract from the National Institute of Mental Health (NIMH) (N01MH80001). The manuscript was approved by the publication committee of STEP-BD. The Massachusetts General Hospital Bipolar Research Program and the University of Pittsburgh Clinical Epidemiology Center coordinated the study. Antidepressant medications were donated by Glaxo Wellcome and SmithKlineBeecham (now GlaxoSmithKline).
Any opinions, findings, conclusions, or recommendations expressed in this article are those of the authors and do not necessarily reflect the views of the NIMH.
Dr. Sachs reports receiving consultant and speaker fees from Abbott Labs, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Merck, Pfizer, Sanofi, and Wyeth and grant support from the NIMH, Abbott Labs, GlaxoSmithKline, Memory Pharmaceuticals, and Repligen. Dr. Nierenberg reports receiving consultant and speaker fees from Abbott Laboratories, Brain Cells, Bristol-Myers Squibb, Genaissance, GlaxoSmithKline, Innapharma, Janssen, Eli Lilly, Novartis, Pfizer, Sepracor, Shire, and Somerset and grant support from Bristol-Myers Squibb, Cederroth, Cyberonics, Forest, GlaxoSmithKline, Janssen, Lichter Pharma, Eli Lilly, NARSAD, Pfizer, the Stanley Foundation, and Wyeth. Dr. Calabrese reports receiving consultant and speaker fees from Abbott, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Pfizer, Solvay, Wyeth, Seriver, and Sanofi-Aventis and grant support from AstraZeneca, the Cleveland Foundation, Eli Lilly, GlaxoSmithKline, Janssen, NARSAD, Novartis, and Wyeth. Dr. Marangell reports receiving consultant and speaker fees from Eli Lilly, GlaxoSmithKline, Cyberonics, Pfizer, Medtronics, Forest, Aspect Medical Systems, and Novartis and grant support from the American Foundation for Suicide Prevention, Aspect Medical Systems, Sanofi, Neuronetics, Bristol-Myers Squibb, and NARSAD. Dr. Wisniewski reports receiving consultant and speaker fees from Cyberonics. Dr. Friedman reports receiving speaker fees from AstraZeneca, Bristol-Myers Squibb, Pfizer, Wyeth, and GlaxoSmithKline and grant support from Bristol-Myers Squibb and Pfizer. Dr. Bowden reports receiving consultant and speaker fees from Abbott, AstraZeneca, GlaxoSmithKline, Janssen, JDS Pharmaceuticals, Eli Lilly, Pfizer, Sanofi, and UCB Pharma and grant support from Abbott, Bristol-Myers Squibb, Elan Pharmaceuticals, GlaxoSmithKline, Janssen, Eli Lilly, Parke-Davis, the R.W. Johnson Pharmaceutical Institute, SmithKline Beecham, and the Stanley Foundation. Dr. Fossey reports receiving speaker fees and grant support from AstraZeneca. Dr. Ostacher reports receiving consultant and speaker fees from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, and Janssen and grant support from NARSAD, the Cohen Family Foundation, and Pfizer. Dr. Ketter reports receiving consultant and speaker fees from Abbott Labs, AstraZeneca, Bristol-Myers Squibb, Elan Pharmaceuticals, Janssen, Jazz Pharmaceuticals, Novartis Pharmaceuticals, Shire, and Solvay and grant support from Abbott Labs, AstraZeneca, GlaxoSmithKline, Elan Pharmaceuticals, Memory Pharmaceuticals, Repligen, NARSAD, and Wyeth. Dr. Patel reports receiving consultant and speaker fees from Bristol-Myers Squibb, AstraZeneca, Pfizer, and GlaxoSmithKline and grant support from Bristol-Myers Squibb. Dr. Hauser reports receiving consultant and speaker fees from AstraZeneca, Janssen, Bristol-Myers Squibb, and Roche Labs. Dr. Rapport reports receiving consultant and speaker fees from Novartis, Forest, GlaxoSmithKline, Bristol-Myers Squibb, and Pfizer and grant support from the University of Toledo College of Medicine. Dr. Martinez reports receiving consultant and speaker fees from Cyberonics, Eli Lilly, Janssen, AstraZeneca, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Pfizer, and Wyeth and grant support from Sanofi, Neuronetics, and Bristol-Myers Squibb. Dr. Allen reports receiving consultant and speaker fees from Abbott, Alexza Molecular Delivery, Pfizer, AstraZeneca, Bristol-Myers Squibb, and Janssen and grant support from NARSAD. Dr. Miklowitz reports receiving consultant and speaker fees from Eli Lilly and grant support from the Robert Sutherland Foundation. Dr. Otto reports receiving consultant and speaker fees from Organon, Pfizer, and Sanofi. Dr. Dennehy reports receiving speaker fees from GlaxoSmithKline. Dr. Thase reports receiving consultant and speaker fees from AstraZeneca, Bristol-Myers Squibb, Cephalon, Cyberonics, Eli Lilly, Forest, GlaxoSmithKline, Janssen, Novartis, Organon, Pfizer, Sepracor, Shire, and Wyeth. No other potential conflict of interest relevant to this article was reported.
This article (10.1056/NEJMoa064135) was published at www.nejm.org on March 28, 2007.
Source Information
From Massachusetts General Hospital, Harvard Medical School (G.S.S., A.A.N., M.J.O.), and Boston University (M.W.O.) — all in Boston; Case Western Reserve University–University Hospitals Case Medical Center, Cleveland (J.R.C.); Baylor College of Medicine and South Central Mental Illness Research Education and Clinical Core — both in Houston (L.B.M., J.M.M.); the University of Pittsburgh (S.R.W.) and University of Pittsburgh School of Medicine (E.S.F., M.E.T.) — both in Pittsburgh; the University of Pennsylvania, Philadelphia (L.G.); the University of Texas Health Science Center, San Antonio (C.L.B.); the University of Oklahoma College of Medicine–Tulsa, Tulsa (M.D.F.); Stanford University School of Medicine, Stanford, CA (T.A.K.); the University of Massachusetts Medical School, Worcester (J.P.); the Portland Veterans Affairs Medical Center and Oregon Health and Sciences University — both in Portland (P.H.); the University of Toledo College of Medicine, Toledo, OH (D.R.); the University of Colorado Health Sciences Center, Denver (M.H.A.); the University of Colorado, Boulder, and University of Colorado Health Sciences Center, Boulder (D.J.M.); and Purdue University, West Lafayette, IN (E.B.D.).
Address reprint requests to Dr. Sachs at the Bipolar Clinic and Research Program, Massachusetts General Hospital, 50 Staniford St., Suite 580, Boston, MA 02114, or at gsachs@partners.org.
- References
References
1
Murray CJ ,Lopez AD ,Jamison DT . The global burden of disease in 1990: summary results, sensitivity analysis and future directions. Bull World Health Organ 1994;72:495-509
Web of Science | Medline2
Kessler RC ,Demler O ,Frank RG , et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 2005;352:2515-2523
Full Text | Web of Science | Medline3
Simon GE ,Unutzer J . Health care utilization and costs among patients treated for bipolar disorder in an insured population. Psychiatr Serv 1999;50:1303-1308
Web of Science | Medline4
Judd LL ,Akiskal HS ,Schettler PJ , et al. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59:530-537
CrossRef | Web of Science | Medline5
Post RM ,Denicoff KD ,Leverich GS , et al. Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry 2003;64:680-90, 738
CrossRef | Web of Science | Medline6
Perlis RH ,Ostacher MJ ,Patel JK , et al. Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry 2006;163:217-224
CrossRef | Web of Science | Medline7
Goodwin GM . Evidence-based guidelines for treating bipolar disorder: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2003;17:147, 149-73
CrossRef | Web of Science8
Suppes T ,Dennehy EB ,Hirschfeld RM , et al. The Texas Implementation of Medication Algorithms: update to the algorithms for treatment of bipolar I disorder. J Clin Psychiatry 2005;66:870-886
CrossRef | Web of Science | Medline9
Leverich GS ,Altshuler LL ,Frye MA , et al. Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. Am J Psychiatry 2006;163:232-239
CrossRef | Web of Science | Medline10
Ghaemi SN ,Hsu DJ ,Thase ME , et al. Pharmacological treatment patterns at study entry for the first 500 STEP-BD participants. Psychiatr Serv 2006;57:660-665
CrossRef | Web of Science | Medline11
Nemeroff CB ,Evans DL ,Gyulai L , et al. Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry 2001;158:906-912
Web of Science | Medline12
Tohen M ,Vieta E ,Calabrese J , et al. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry 2003;60:1079-1088[Erratum, Arch Gen Psychiatry 2004;61:176.]
CrossRef | Web of Science | Medline13
Sachs GS ,Thase ME ,Otto MW , et al. Rationale, design, and methods of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Biol Psychiatry 2003;53:1028-1042
CrossRef | Web of Science | Medline14
Spitzer RL ,Williams JB ,Gibbon M ,First MB . The Structured Clinical Interview for DSM-III-R (SCID). I. History, rationale, and description. Arch Gen Psychiatry 1992;49:624-629
CrossRef | Web of Science | Medline15
Sheehan DV ,Lecrubier Y ,Sheehan KH , et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59:Suppl 20:22-57
Web of Science | Medline16
Goldberg JF ,Allen MH ,Miklowitz DA , et al. Suicidal ideation and pharmacotherapy among STEP-BD patients. Psychiatr Serv 2005;56:1534-1540
CrossRef | Web of Science | Medline17
Sachs GS ,Lafer B ,Stoll AL , et al. A double-blind trial of bupropion versus desipramine for bipolar depression. J Clin Psychiatry 1994;55:391-393
Web of Science | Medline18
Miklowitz DJ, Otto MW, Frank E, et al. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry (in press).
19
Sachs GS ,Guille C ,McMurrich SL . A Clinical Monitoring Form for mood disorders. Bipolar Disord 2002;4:323-327
CrossRef | Web of Science | Medline20
Kessler RC ,Chiu WT ,Demler O ,Merikangas KR ,Walters EE . Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:617-627[Erratum, Arch Gen Psychiatry 2005:62:709.]
CrossRef | Web of Science | Medline21
Gijsman HJ ,Geddes JR ,Rendell JM ,Nolen WA ,Goodwin GM . Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry 2004;161:1537-1547
CrossRef | Web of Science | Medline22
American Psychiatric Association
CrossRef | Web of Science | Medline23
Vieta E ,Martinez-Aran A ,Goikolea JM , et al. A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry 2002;63:508-512
CrossRef | Web of Science | Medline24
Post RM ,Altshuler LL ,Leverich GS , et al. Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry 2006;189:124-131[Erratum, Br J Psychiatry 2006;189:569.]
CrossRef | Web of Science | Medline25
Frank E ,Swartz HA ,Mallinger AG ,Thase ME ,Weaver EV ,Kupfer DJ . Adjunctive psychotherapy for bipolar disorder: effects of changing treatment modality. J Abnorm Psychol 1999;108:579-587
CrossRef | Web of Science | Medline26
Scott J ,Paykel E ,Morriss R , et al. Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial. Br J Psychiatry 2006;188:313-320
CrossRef | Web of Science | Medline
- Citing Articles (171)
Citing Articles
1
Martin Bares, Tomas Novak, Martin Brunovsky, Miloslav Kopecek, Pavla Stopkova, Vladimir Krajca, Cyril Höschl. (2012) The change of QEEG prefrontal cordance as a response predictor to antidepressive intervention in bipolar depression. A pilot study. Journal of Psychiatric Research 46:2, 219-225
CrossRef2
Pichai Ittasakul, Kaja R. Johnson, Shefali Srivastava, Meredith E. Childers, John O. Brooks, Jennifer C. Hoblyn, Terence A. Ketter. (2012) Effectiveness of quetiapine plus lamotrigine maintenance therapy in challenging bipolar disorder patients. Journal of Affective Disorders
CrossRef3
Richard B. Berry. 2012. Psychiatry and Sleep. , 593-613.
CrossRef4
Joanna M. Biernacka, Susan L. McElroy, Scott Crow, Alexis Sharp, Joachim Benitez, Marin Veldic, Simon Kung, Julie M. Cunningham, Robert M. Post, David Mrazek, Mark A. Frye. (2012) Pharmacogenomics of antidepressant induced mania: A review and meta-analysis of the serotonin transporter gene (5HTTLPR) association. Journal of Affective Disorders 136:1-2, e21-e29
CrossRef5
Xiaohua Li, Mark A Frye, Richard C Shelton. (2012) Review of Pharmacological Treatment in Mood Disorders and Future Directions for Drug Development. Neuropsychopharmacology 37:1, 77-101
CrossRef6
Janusz K. Rybakowski. (2012) Bipolarity and inadequate response to antidepressant drugs: Clinical and psychopharmacological perspective. Journal of Affective Disorders 136:1-2, e13-e19
CrossRef7
Ben H. Amit, Abraham Weizman. (2012) Antidepressant Treatment for Acute Bipolar Depression: An Update. Depression Research and Treatment 2012, 1-10
CrossRef8
G. M. Goodwin. (2012) Bipolar depression and treatment with antidepressants. The British Journal of Psychiatry 200:1, 5-6
CrossRef9
Claudia F. Baldassano, Alexander Hosey, Jordan Coello. (2011) Bipolar Depression: An Evidence-Based Approach. Current Psychiatry Reports 13:6, 483-487
CrossRef10
J. Scott, B. Etain. (2011) Which psychosocial interventions in bipolar depression ?. L'Encéphale 37, S214-S217
CrossRef11
Maju Mathew Koola, Jan A. Fawcett, Deanna L. Kelly. (2011) Case Report on the Management of Depression in Schizoaffective Disorder, Bipolar Type Focusing on Lithium Levels and Measurement-Based Care. The Journal of Nervous and Mental Disease 199:12, 989-990
CrossRef12
P. Courtet, L. Samalin, E. Olié. (2011) Les antidépresseurs dans le trouble bipolaire. L'Encéphale 37, S196-S202
CrossRef13
Robin Nusslock, Ellen Frank. (2011) Subthreshold bipolarity: diagnostic issues and challenges. Bipolar Disorders 13:7-8, 587-603
CrossRef14
Waldemar Greil, Anne Häberle, Patrick Haueis, Renate Grohmann, Stefan Russmann. (2011) Pharmacotherapeutic trends in 2231 psychiatric inpatients with bipolar depression from the International AMSP Project between 1994 and 2009. Journal of Affective Disorders
CrossRef15
D. J. Smith, N. Craddock. (2011) Unipolar and bipolar depression: different or the same?. The British Journal of Psychiatry 199:4, 272-274
CrossRef16
Ahmed Okasha. (2011) The dilemma in the concept and the management of bipolar disorder. Middle East Current Psychiatry 18:4, 190-194
CrossRef17
Oscar Heeren, Manuel Sánchez De Carmona, Gustavo Vásquez, Rodrigo Córdoba, Jorge Forero, Luis Madrid, Diogo Lara, Rafael Medina, Luis Meza. (2011) Tratamiento psicofarmacológico del trastorno bipolar en América Latina. Revista de Psiquiatría y Salud Mental 4:4, 205-211
CrossRef18
Diogo R. Lara, Luisa W. Bisol, Miriam G. Brunstein, Caroline T. Reppold, Hudson W. de Carvalho, Gustavo L. Ottoni. (2011) The Affective and Emotional Composite Temperament (AFECT) model and scale: A system-based integrative approach. Journal of Affective Disorders
CrossRef19
James Offord. (2011) Genetic approaches to a better understanding of bipolar disorder. Pharmacology & Therapeutics
CrossRef20
Lucas Spanemberg, Raffael Massuda, Lucas Lovato, Leonardo Paim, Edgar Arrua Vares, Neusa Sica da Rocha, Keila Maria Mendes Ceresér. (2011) Pharmacological Treatment of Bipolar Depression: Qualitative Systematic Review of Double-Blind Randomized Clinical Trials. Psychiatric Quarterly
CrossRef21
Peijun Chen, Irina Korobkova, Katherine Busby, Martha Sajatovic. (2011) Managing late-life bipolar disorder: an update. Aging Health 7:4, 557-571
CrossRef22
Konstantinos N. Fountoulakis. (2011) Refractoriness in Bipolar Disorder: Definitions and Evidence-Based Treatment. CNS Neuroscience & Therapeuticsno-no
CrossRef23
Anwar Mechri, Neila Kerkeni, Imen Touati, Miloud Bacha, Leila Gassab. (2011) Association between cyclothymic temperament and clinical predictors of bipolarity in recurrent depressive patients. Journal of Affective Disorders 132:1-2, 285-288
CrossRef24
Colleen Loo, Natalie Katalinic, Philip B. Mitchell, Benjamin Greenberg. (2011) Physical treatments for bipolar disorder: A review of electroconvulsive therapy, stereotactic surgery and other brain stimulation techniques. Journal of Affective Disorders 132:1-2, 1-13
CrossRef25
Erin K. Kastenschmidt, Gary J. Kennedy. (2011) Depression and Anxiety in Late Life: Diagnostic Insights and Therapeutic Options. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 78:4, 527-545
CrossRef26
D. J. Smith, E. Griffiths, M. Kelly, K. Hood, N. Craddock, S. A. Simpson. (2011) Unrecognised bipolar disorder in primary care patients with depression. The British Journal of Psychiatry 199:1, 49-56
CrossRef27
Jan Fawcett. (2011) This Issue: The Conundrum of Bipolar Depression. Psychiatric Annals 41:7, 333-335
CrossRef28
J. Kuenzel, I. Blanchette, E.H. Zandstra, A. Thomas, W. El-Deredy. (2011) Awareness changes placebo effects for feeling relaxed, but not for liking. Journal of Marketing Communications110927093134003
CrossRef29
Ji Hyun Baek, Dong Yeon Park, Jungmi Choi, Ji Sun Kim, Ji Sun Choi, Kyooseob Ha, Jun Soo Kwon, Dongsoo Lee, Kyung Sue Hong. (2011) Differences between bipolar I and bipolar II disorders in clinical features, comorbidity, and family history. Journal of Affective Disorders 131:1-3, 59-67
CrossRef30
Antonio Tundo, Paola Cavalieri, Serena Navari, Fulvia Marchetti. (2011) Treating bipolar depression - antidepressants and alternatives: a critical review of the literature. Acta Neuropsychiatrica 23:3, 94-105
CrossRef31
Emanuel Severus, Nadine Schaaff, Hans-Jürgen Möller. (2011) State of the Art: Treatment of Bipolar Disorders. CNS Neuroscience & Therapeuticsno-no
CrossRef32
I. Pacchiarotti, M. Valentí, C.M. Bonnin, A.R. Rosa, A. Murru, G.D. Kotzalidis, A.M.A. Nivoli, J. Sánchez-Moreno, E. Vieta, F. Colom. (2011) Factors associated with initial treatment response with antidepressants in bipolar disorder. European Neuropsychopharmacology 21:5, 362-369
CrossRef33
C.L. Bowden, R.H. Perlis, M.E. Thase, T.A. Ketter, M.M. Ostacher, J.R. Calabrese, N.A. Reilly-Harrington, J.M. Gonzalez, V. Singh, A.A. Nierenberg, G.S. Sachs. (2011) Aims and Results of the NIMH Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). CNS Neuroscience & Therapeuticsno-no
CrossRef34
Konstantinos N. Fountoulakis, John R. Kelsoe, Hagop Akiskal. (2011) Receptor targets for antidepressant therapy in bipolar disorder: An overview. Journal of Affective Disorders
CrossRef35
Hsien-Chang Lin, Steven R. Erickson, Rajesh Balkrishnan. (2011) Antidepressant Utilization, Adherence, and Health Care Spending in the United States: The Case of MDD Patients 2000-2007. Health Outcomes Research in Medicine 2:2, e79-e89
CrossRef36
2011. References. , 209-234.
CrossRef37
Philip S. Wang, Alan M. Brookhart, Christine Ulbricht, Sebastian Schneeweiss. 2011. The Pharmacoepidemiology of Psychiatric Medications. , 155-165.
CrossRef38
Susan L. McElroy, Lesley M. Arnold, Lori L. Altshuler. 2011. Bipolarity in Women: Therapeutic Issues. , 317-350.
CrossRef39
Boghos I. Yerevanian. 2011. The Role of Antidepressants in Bipolar Disorder. , 299-316.
CrossRef40
Hagop S. Akiskal, Kareen K. Akiskal. 2011. Overview of Principles of Caring for Bipolar Patients. , 487-507.
CrossRef41
David E. Kemp, Stephen J. Ganocy, Martin Brecher, Berit X. Carlson, Suzanne Edwards, James M. Eudicone, Gary Evoniuk, Wim Jansen, Andrew C. Leon, Margaret Minkwitz, Andrei Pikalov, Hans H. Stassen, Armin Szegedi, Mauricio Tohen, Arjen P.P. Van Willigenburg, Joseph R. Calabrese. (2011) Clinical value of early partial symptomatic improvement in the prediction of response and remission during short-term treatment trials in 3369 subjects with bipolar I or II depression. Journal of Affective Disorders 130:1-2, 171-179
CrossRef42
Rodrigo Machado-Vieira, Carlos A. Zarate. (2011) Proof of concept trials in bipolar disorder and major depressive disorder: a translational perspective in the search for improved treatments. Depression and Anxiety 28:4, 267-281
CrossRef43
T. A. Ketter, L. Citrome, P. W. Wang, J. L. Culver, S. Srivastava. (2011) Treatments for bipolar disorder: can number needed to treat/harm help inform clinical decisions?. Acta Psychiatrica Scandinavica 123:3, 175-189
CrossRef44
Alessandra M.A. Nivoli, Francesc Colom, Andrea Murru, Isabella Pacchiarotti, Piero Castro-Loli, Ana González-Pinto, Kostas N. Fountoulakis, Eduard Vieta. (2011) New treatment guidelines for acute bipolar depression: A systematic review. Journal of Affective Disorders 129:1-3, 14-26
CrossRef45
Eiran Vadim Harel, Abraham Zangen, Yiftach Roth, Irving Reti, Yoram Braw, Yechiel Levkovitz. (2011) H-coil repetitive transcranial magnetic stimulation for the treatment of bipolar depression: an add-on, safety and feasibility study. World Journal of Biological Psychiatry 12:2, 119-126
CrossRef46
Marc Valentí, Isabella Pacchiarotti, Adriane R Rosa, C Mar Bonnín, Dina Popovic, Alessandra M A Nivoli, Andrea Murru, Íria Grande, Francesc Colom, Eduard Vieta. (2011) Bipolar mixed episodes and antidepressants: a cohort study of bipolar I disorder patients. Bipolar Disorders 13:2, 145-154
CrossRef47
Jared W. Young, Brook L Henry, Mark A. Geyer. (2011) Predictive animal models of mania, hits, misses, and future directions. British Journal of Pharmacologyno-no
CrossRef48
Marc LM van der Loos, Paul Mulder, Erwin GThM Hartong, Marc BJ Blom, Anton C Vergouwen, Martijn S van Noorden, Manuela A Timmermans, Eduard Vieta, Willem A Nolen, . (2011) Long-term outcome of bipolar depressed patients receiving lamotrigine as add-on to lithium with the possibility of the addition of paroxetine in nonresponders: a randomized, placebo-controlled trial with a novel design. Bipolar Disorders 13:1, 111-117
CrossRef49
Frye, Mark A., . (2011) Bipolar Disorder — A Focus on Depression. New England Journal of Medicine 364:1, 51-59
Full Text50
Konstantinos N Fountoulakis, Xenia Gonda, Eduard Vieta, Zoltan Rihmer. (2011) Class effect of pharmacotherapy in bipolar disorder: fact or misbelief?. Annals of General Psychiatry 10:1, 8
CrossRef51
Roy H Perlis, Michael J Ostacher, Joseph F Goldberg, David J Miklowitz, Edward Friedman, Joseph Calabrese, Michael E Thase, Gary S Sachs. (2010) Transition to Mania During Treatment of Bipolar Depression. Neuropsychopharmacology 35:13, 2545-2552
CrossRef52
T. Javelot, H. Javelot, A. Baratta, L. Weiner, M. Messaoudi, P. Lemoine. (2010) Troubles psychotiques aigus liés au bupropion : revue de la littérature. L'Encéphale 36:6, 461-471
CrossRef53
Jan Fawcett. (2010) An Overview of Mood Disorders in the DSM-5. Current Psychiatry Reports 12:6, 531-538
CrossRef54
Jun Chen, Yiru Fang, David E. Kemp, Joseph R. Calabrese, Keming Gao. (2010) Switching to Hypomania and Mania: Differential Neurochemical, Neuropsychological, and Pharmacologic Triggers and Their Mechanisms. Current Psychiatry Reports 12:6, 512-521
CrossRef55
William V Bobo, Richard C Shelton. (2010) Risperidone long-acting injectable (Risperdal Consta ® ) for maintenance treatment in patients with bipolar disorder. Expert Review of Neurotherapeutics 10:11, 1637-1658
CrossRef56
Nir Lipsman, Roger S McIntyre, Peter Giacobbe, Cristina Torres, Sidney H Kennedy, Andres M Lozano. (2010) Neurosurgical treatment of bipolar depression: defining treatment resistance and identifying surgical targets. Bipolar Disorders 12:7, 691-701
CrossRef57
Gin S Malhi. (2010) The king is dead, long live the king! The restoration of BALANCE. Bipolar Disorders 12:7, 681-684
CrossRef58
Terence A. Ketter, John O. Brooks, Jennifer C. Hoblyn, Anne A. Holland, Jennifer Y. Nam, Jenifer L. Culver, Wendy K. Marsh, Julie C. Bonner. (2010) Long-term effectiveness of quetiapine in bipolar disorder in a clinical setting. Journal of Psychiatric Research 44:14, 921-929
CrossRef59
Allan H. Young, Charles B. Nemeroff. 2010. Pharmacological Treatment of Bipolar Depression. , 294-303.
CrossRef60
Gordon Parker, Terence A. Ketter. 2010. Management of Bipolar II Disorder. , 342-352.
CrossRef61
Rodrigo Machado-Vieira, Husseini K. Manji, Carlos A. Zarate. 2010. Novel Therapeutic Strategies for Bipolar Disorder. , 395-411.
CrossRef62
Jan Fawcett. 2010. DSM-V Perspectives on Classification of Bipolar Disorder. , 44-51.
CrossRef63
Eduard Vieta, Julie Locklear, Oliver Günther, Mattias Ekman, Carolin Miltenburger, Mary Lou Chatterton, Mikael Åström, Björn Paulsson. (2010) Treatment Options for Bipolar Depression. Journal of Clinical Psychopharmacology 30:5, 579-590
CrossRef64
David J. Miklowitz. 2010. Family Therapy Approaches to Bipolar Disorder. , 443-452.
CrossRef65
Philippa L Rock, Guy M Goodwin, Catherine J Harmer. (2010) The common adolescent bipolar phenotype shows positive biases in emotional processing. Bipolar Disorders 12:6, 606-615
CrossRef66
Jan Fawcett. (2010) We Need to Keep Learning from One Another. Psychiatric Annals 40:9, 425-426
CrossRef67
Matthew J. Taylor, Srijan Sen, Zubin Bhagwagar. (2010) Antidepressant Response and the Serotonin Transporter Gene-Linked Polymorphic Region. Biological Psychiatry 68:6, 536-543
CrossRef68
M. L. M. Van Der Loos, P. Mulder, E. G. Th. M. Hartong, M. B. J. Blom, A. C. Vergouwen, M. S. Van Noorden, M. A. Timmermans, E. Vieta, W. A. Nolen, . (2010) Efficacy and safety of two treatment algorithms in bipolar depression consisting of a combination of lithium, lamotrigine or placebo and paroxetine. Acta Psychiatrica Scandinavica 122:3, 246-254
CrossRef69
Julien Mendlewicz, Isabelle Massat, Sylvie Linotte, Siegfried Kasper, Anastasios Konstantinidis, Yves Lecrubier, Stuart Montgomery, Alessandro Serretti, Joseph Zohar, Daniel Souery. (2010) Identification of clinical factors associated with resistance to antidepressants in bipolar depression: results from an European Multicentre Study. International Clinical Psychopharmacology 25:5, 297-301
CrossRef70
Rif S. El-Mallakh, Praveen Penagaluri, Arun Kantamneni, Yonglin Gao, Rona J. Roberts. (2010) Long-Term Use of Pramipexole in Bipolar Depression: A Naturalistic Retrospective Chart Review. Psychiatric Quarterly 81:3, 207-213
CrossRef71
Michael Berk, Felicity Ng, Seetal Dodd, Joseph F. Goldberg, Gin S. Malhi. (2010) Do we need to flick the switch? The need for a broader conceptualization of iatrogenic course aggravation in clinical trials of bipolar disorder. Psychiatry and Clinical Neurosciences 64:4, 367-371
CrossRef72
David J. Bond, Raymond W. Lam, Lakshmi N. Yatham. (2010) Divalproex sodium versus placebo in the treatment of acute bipolar depression: A systematic review and meta-analysis. Journal of Affective Disorders 124:3, 228-234
CrossRef73
Liz Forty, Mark Kelly, Lisa Jones, Ian Jones, Emma Barnes, Sian Caesar, Christine Fraser, Katherine Gordon-Smith, Emily Griffiths, Nick Craddock, Daniel J Smith. (2010) Reducing the Hypomania Checklist (HCL-32) to a 16-item version. Journal of Affective Disorders 124:3, 351-356
CrossRef74
P.W. Wang, C. Nowakowska, R.A. Chandler, S.J. Hill, J.Y. Nam, J.L. Culver, K.L. Keller, T.A. Ketter. (2010) Divalproex extended-release in acute bipolar II depression. Journal of Affective Disorders 124:1-2, 170-173
CrossRef75
Christopher P Alderman, Dasha Loutchkina, Anita C Abarno. (2010) Psychotropic drug safety issues: continuing vigilance is needed. Expert Review of Clinical Pharmacology 3:4, 427-432
CrossRef76
Jorge M. Tamayo, Carlos A. Zarate, Eduard Vieta, Gustavo Vázquez, Mauricio Tohen. (2010) Level of response and safety of pharmacological monotherapy in the treatment of acute bipolar I disorder phases: a systematic review and meta-analysis. The International Journal of Neuropsychopharmacology 13:06, 813-832
CrossRef77
Polina Eidelman, Lisa S. Talbot, June Gruber, Allison G. Harvey. (2010) Sleep, illness course, and concurrent symptoms in inter-episode bipolar disorder. Journal of Behavior Therapy and Experimental Psychiatry 41:2, 145-149
CrossRef78
L. Tondo, G. Vázquez, R. J. Baldessarini. (2010) Mania associated with antidepressant treatment: comprehensive meta-analytic review. Acta Psychiatrica Scandinavica 121:6, 404-414
CrossRef79
Jay D. Amsterdam, Justine Shults. (2010) Efficacy and Mood Conversion Rate of Short-Term Fluoxetine Monotherapy of Bipolar II Major Depressive Episode. Journal of Clinical Psychopharmacology 30:3, 306-311
CrossRef80
Pierpaolo Medda, Giulio Perugi, Sara Zanello, Marika Ciuffa, Salvatore Rizzato, Giovanni Battista Cassano. (2010) Comparative Response to Electroconvulsive Therapy in Medication-Resistant Bipolar I Patients With Depression and Mixed State. The Journal of ECT 26:2, 82-86
CrossRef81
H. Grunze, S. Dargel. (2010) Akut- und Langzeittherapie der bipolaren Depressionen. Der Nervenarzt 81:5, 539-548
CrossRef82
R. J. Van Lieshout, G. M. MacQueen. (2010) Efficacy and acceptability of mood stabilisers in the treatment of acute bipolar depression: systematic review. The British Journal of Psychiatry 196:4, 266-273
CrossRef83
Janusz K. Rybakowski, Jules Angst, Dominika Dudek, Tomasz Pawlowski, Dorota Lojko, Marcin Siwek, Andrzej Kiejna. (2010) Polish version of the Hypomania Checklist (HCL-32) scale: the results in treatment-resistant depression. European Archives of Psychiatry and Clinical Neuroscience 260:2, 139-144
CrossRef84
J. D. Amsterdam, G. Wang, J. Shults. (2010) Venlafaxine monotherapy in bipolar type II depressed patients unresponsive to prior lithium monotherapy. Acta Psychiatrica Scandinavica 121:3, 201-208
CrossRef85
Arnim Quante, Sara Zeugmann, Alexander Luborzewski, Nicole Schommer, Jens Langosch, Christoph Born, Ion Anghelescu, Juergen Wolf. (2010) Aripiprazole as adjunct to a mood stabilizer and citalopram in bipolar depression: a randomized placebo-controlled pilot study. Human Psychopharmacology: Clinical and Experimental 25:2, 126-132
CrossRef86
Peter C. Austin, Andrea Manca, Merrick Zwarenstein, David N. Juurlink, Matthew B. Stanbrook. (2010) A substantial and confusing variation exists in handling of baseline covariates in randomized controlled trials: a review of trials published in leading medical journals. Journal of Clinical Epidemiology 63:2, 142-153
CrossRef87
Howard G. Birnbaum, Rym Ben-Hamadi, David Kelley, Matthew Hsieh, Brian Seal, Evan Kantor, Pierre Y. Cremieux, Paul E. Greenberg. (2010) Assessing the Relationship Between Compliance With Antidepressant Therapy and Employer Costs Among Employees in the United States. Journal of Occupational and Environmental Medicine 52:2, 115-124
CrossRef88
Bret R. Rutherford, Steven P. Roose. 2010. Tricyclic Antidepressants. .
CrossRef89
Arash Ansari, David N. Osser. (2010) The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An Update on Bipolar Depression. Harvard Review of Psychiatry 18:1, 36-55
CrossRef90
D. Pringuey, F. Cherikh, O. Tible, B. Giordana. (2010) Traitement d’un premier épisode dépressif dans le cadre du trouble bipolaire. L'Encéphale 36, S27-S33
CrossRef91
William V. Bobo, Richard A. Epstein, Richard C. Shelton. (2010) Olanzapine monotherapy for acute depression in patients with bipolar I or II disorder: results of an 8-week open label trial. Human Psychopharmacology: Clinical and Experimental 25:1, 30-36
CrossRef92
Arnim Quante, Sara Zeugmann, Francesca Regen, Annette Engelhardt, Ion-George Anghelescu. (2010) Psychopharmacological Treatment Status in Outpatients with Bipolar Disorder: A Clinical Survey in Germany. Psychiatry Investigation 7:3, 155
CrossRef93
I. Pacchiarotti, L. Mazzarini, F. Colom, J. Sanchez-Moreno, P. Girardi, G. D. Kotzalidis, E. Vieta. (2009) Treatment-resistant bipolar depression: towards a new definition. Acta Psychiatrica Scandinavica 120:6, 429-440
CrossRef94
C. Born, N.-N. Seitz, H. Grunze, E. Vieta, S. Dittmann, F. Seem
ller, B. Amann. (2009) Preliminary results of a fine-grain analysis of mood swings and treatment modalities of bipolar I and II patients using the daily prospective life-chart-methodology. Acta Psychiatrica Scandinavica 120:6, 474-480
CrossRef95
D. P. Goldberg, G. Andrews, M. J. Hobbs. (2009) Where should bipolar disorder appear in the meta-structure?. Psychological Medicine 39:12, 2071
CrossRef96
P. Medda, G. Perugi, S. Zanello, M. Ciuffa, G.B. Cassano. (2009) Response to ECT in bipolar I, bipolar II and unipolar depression. Journal of Affective Disorders 118:1-3, 55-59
CrossRef97
Michael R. Liebowitz, Ester Salmán, Arnold Mech, David Dunner, Ann E. Johnson, Jamil Akhtar, Rajiv Pratap. (2009) Ziprasidone monotherapy in bipolar II depression: An open trial. Journal of Affective Disorders 118:1-3, 205-208
CrossRef98
Daniel Z. Lieberman, George Kolodner, Suena H. Massey, Kenneth P. Williams. (2009) Antidepressant-Induced Mania with Concomitant Mood Stabilizer in Patients with Comorbid Substance Abuse and Bipolar Disorder. Journal of Addictive Diseases 28:4, 348-355
CrossRef99
Stanley I. Rapoport, Mireille Basselin, Hyung-Wook Kim, Jagadeesh S. Rao. (2009) Bipolar disorder and mechanisms of action of mood stabilizers. Brain Research Reviews 61:2, 185-209
CrossRef100
Gin S. Malhi, Danielle Adams, Catherine M. Cahill, Seetal Dodd, Michael Berk. (2009) The Management of Individuals with Bipolar Disorder. Drugs 69:15, 2063-2101
CrossRef101
Eric G. Smith, Alexis D. Henry, Jianying Zhang, Fred Hooven, Steven M. Banks. (2009) Antidepressant Adequacy and Work Status Among Medicaid Enrollees with Disabilities: A Restriction-based, Propensity Score-adjusted Analysis. Community Mental Health Journal 45:5, 333-340
CrossRef102
Joseph C. Wu, John R. Kelsoe, Carol Schachat, Blynn G. Bunney, Anna DeModena, Shahrokh Golshan, J. Christian Gillin, Steven G. Potkin, William E. Bunney. (2009) Rapid and Sustained Antidepressant Response with Sleep Deprivation and Chronotherapy in Bipolar Disorder. Biological Psychiatry 66:3, 298-301
CrossRef103
Jorge M. Tamayo, Virginia K. Sutton, Manuel A. Mattei, Barbara Diaz, Hassan H. Jamal, Eduard Vieta, Carlos A. Zarate, Ileana Fumero, Mauricio Tohen. (2009) Effectiveness and Safety of the Combination of Fluoxetine and Olanzapine in Outpatients With Bipolar Depression. Journal of Clinical Psychopharmacology 29:4, 358-361
CrossRef104
Philip B Mitchell, Colleen K Loo, Michael Breakspear. (2009) Recent progress in the pharmacotherapy of bipolar disorder. Future Neurology 4:4, 493-508
CrossRef105
Vivek Datta, Anthony J Cleare. (2009) Recent advances in bipolar disorder pharmacotherapy: focus on bipolar depression and rapid cycling. Expert Review of Clinical Pharmacology 2:4, 423-434
CrossRef106
Michael E. Thase. (2009) A Commentary on “Sleep Disturbance in Bipolar Disorder”. Clinical Psychology: Science and Practice 16:2, 278-280
CrossRef107
David J Muzina. (2009) Pharmacologic treatment of rapid cycling and mixed states in bipolar disorder: an argument for the use of lithium. Bipolar Disorders 11, 84-91
CrossRef108
Samuel Gershon, KN Roy Chengappa, Gin S Malhi. (2009) Lithium specificity in bipolar illness: a classic agent for the classic disorder. Bipolar Disorders 11, 34-44
CrossRef109
Pascal Sienaert, Kristof Vansteelandt, Koen Demyttenaere, Joseph Peuskens. (2009) Ultra-brief pulse ECT in bipolar and unipolar depressive disorder: differences in speed of response. Bipolar Disorders 11:4, 418-424
CrossRef110
Gin S Malhi, Danielle Adams, Michael Berk. (2009) Medicating mood with maintenance in mind: bipolar depression pharmacotherapy. Bipolar Disorders 11, 55-76
CrossRef111
Michele P. Kelly, Sheree F. Logue, Jason M. Dwyer, Chad E. Beyer, Heather Majchrowski, Zhang Cai, Zhi Liu, Adedayo Adedoyin, Sharon Rosenzweig-Lipson, Thomas A. Comery. (2009) The supra-additive hyperactivity caused by an amphetamine–chlordiazepoxide mixture exhibits an inverted-U dose response: Negative implications for the use of a model in screening for mood stabilizers. Pharmacology Biochemistry and Behavior 92:4, 649-654
CrossRef112
Sujung J Yoon, In Kyoon Lyoo, Charlotte Haws, Tae-Suk Kim, Bruce M Cohen, Perry F Renshaw. (2009) Decreased Glutamate/Glutamine Levels May Mediate Cytidine’s Efficacy in Treating Bipolar Depression: A Longitudinal Proton Magnetic Resonance Spectroscopy Study. Neuropsychopharmacology 34:7, 1810-1818
CrossRef113
Luke Clark, Samuel R. Chamberlain, Barbara J. Sahakian. (2009) Neurocognitive Mechanisms in Depression: Implications for Treatment. Annual Review of Neuroscience 32:1, 57-74
CrossRef114
James M. Bolton, Jennifer Robinson, Jitender Sareen. (2009) Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Affective Disorders 115:3, 367-375
CrossRef115
David J Miklowitz, Jan Scott. (2009) Psychosocial treatments for bipolar disorder: cost-effectiveness, mediating mechanisms, and future directions. Bipolar Disorders 11, 110-122
CrossRef116
Lakshmi N Yatham, Sidney H Kennedy, Ayal Schaffer, Sagar V Parikh, Serge Beaulieu, Claire O'Donovan, Glenda MacQueen, Roger S McIntyre, Verinder Sharma, Arun Ravindran, L Trevor Young, Allan H Young, Martin Alda, Roumen Milev, Eduard Vieta, Joseph R Calabrese, Michael Berk, Kyooseob Ha, Flávio Kapczinski. (2009) Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disorders 11:3, 225-255
CrossRef117
Enrique Baca-Garcia, Leo Sher, M. Mercedes Perez-Rodriguez, Ainsley K. Burke, Gregory M. Sullivan, Michael F. Grunebaum, Barbara H. Stanley, J. John Mann, Maria A. Oquendo. (2009) Treatment of depressed bipolar patients with alcohol use disorders: Plenty of room for improvement. Journal of Affective Disorders 115:1-2, 262-268
CrossRef118
G. S. Malhi, D. Adams, L. Lampe, M. Paton, N. O’Connor, L. A. Newton, G. Walter, A. Taylor, R. Porter, R. T. Mulder, M. Berk. (2009) Clinical practice recommendations for bipolar disorder. Acta Psychiatrica Scandinavica 119, 27-46
CrossRef119
G. S. Malhi, D. Adams. (2009) Are guidelines in need of CPR? The development of clinical practice recommendations (CPR). Acta Psychiatrica Scandinavica 119, 5-7
CrossRef120
Michael Berk, Gin S. Malhi, Karen Hallam, Clarissa S. Gama, Seetal Dodd, Ana Cristina Andreazza, Benício N. Frey, Flavio Kapczinski. (2009) Early intervention in bipolar disorders: Clinical, biochemical and neuroimaging imperatives. Journal of Affective Disorders 114:1-3, 1-13
CrossRef121
Athanasios Koukopoulos, S. Nassir Ghaemi. (2009) The primacy of mania: A reconsideration of mood disorders. European Psychiatry 24:2, 125-134
CrossRef122
Boris Lorberg, Nagy A. Youssef, Zubin Bhagwagar. (2009) Lamotrigine-associated rash: to rechallenge or not to rechallenge?. The International Journal of Neuropsychopharmacology 12:02, 257
CrossRef123
Sagar V Parikh. (2009) Antidepressants are not all created equal. The Lancet 373:9665, 700-701
CrossRef124
Holly A Swartz, Ellen Frank, Debra R Frankel, Danielle Novick, Patricia Houck. (2009) Psychotherapy as monotherapy for the treatment of bipolar II depression: a proof of concept study. Bipolar Disorders 11:1, 89-94
CrossRef125
Andrew A. Nierenberg. (2009) Lessons from STEP-BD for the treatment of bipolar depression. Depression and Anxiety 26:2, 106-109
CrossRef126
J. R. Geddes, J. R. Calabrese, G. M. Goodwin. (2009) Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. The British Journal of Psychiatry 194:1, 4-9
CrossRef127
Jay D. Amsterdam, Chia-Hao Wang, Michelle Shwarz, Justine Shults. (2009) Venlafaxine versus lithium monotherapy of rapid and non-rapid cycling patients with bipolar II major depressive episode: A randomized, parallel group, open-label trial. Journal of Affective Disorders 112:1-3, 219-230
CrossRef128
K.T. Hallam, D.I. Smith, M. Berk. (2009) Differences between subjective and objective assessments of the utility of Electroconvulsive therapy in patients with bipolar and unipolar depression. Journal of Affective Disorders 112:1-3, 212-218
CrossRef129
Philip S Wang, Robert Heinssen, Molly Oliveri, Ann Wagner, Wayne Goodman. (2009) Bridging Bench and Practice: Translational Research for Schizophrenia and Other Psychotic Disorders. Neuropsychopharmacology 34:1, 204-212
CrossRef130
Nicholas A. Keks, Christine Hill, Suresh Sundram, Annette Graham, Kylee Bellingham, Brian Dean, Ken Opeskin, Arrigo Dorissa, David L. Copolov. (2009) Evaluation of treatment in 35 cases of bipolar suicide. Australian and New Zealand Journal of Psychiatry 43:6, 503-508
CrossRef131
Gin S Malhi. (2008) Upping the ante on antidepressants. Bipolar Disorders 10:8, 975-978
CrossRef132
S Nassir Ghaemi. (2008) Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression. Bipolar Disorders 10:8, 957-968
CrossRef133
Richard C. Shelton, Rakesh Reddy. (2008) Adjunctive use of modafinil in bipolar patients: just another stimulant or not?. Current Psychiatry Reports 10:6, 520-524
CrossRef134
Joseph F Goldberg. (2008) The modern pharmacopoeia: a return to depressive realism?. Bipolar Disorders 10:8, 969-972
CrossRef135
Keming Gao, David E Kemp, Stephen J Ganocy, David J Muzina, Guohua Xia, Robert L Findling, Joseph R Calabrese. (2008) Treatment-emergent mania/hypomania during antidepressant monotherapy in patients with rapid cycling bipolar disorder. Bipolar Disorders 10:8, 907-915
CrossRef136
Surrey M Walton, Glen T Schumock, Ky-Van Lee, G. Caleb Alexander, David Meltzer, Randall S Stafford. (2008) Prioritizing Future Research on Off-Label Prescribing: Results of a Quantitative Evaluation. Pharmacotherapy 28:12, 1443-1452
CrossRef137
Rif S. El-Mallakh, S. Nassir Ghaemi, Kemal Sagduyu, Michael E. Thase, Stephen R. Wisniewski, Andrew A. Nierenberg, Hong Wei Zhang, Tamara A. Pardo, Gary Sachs. (2008) Antidepressant-associated chronic irritable dysphoria (ACID) in STEP-BD patients. Journal of Affective Disorders 111:2-3, 372-377
CrossRef138
Richard. Morriss. (2008) Implementing clinical guidelines for bipolar disorder. Psychology and Psychotherapy: Theory, Research and Practice 81:4, 437-458
CrossRef139
R. W. Licht, H. Gijsman, W. A. Nolen, J. Angst. (2008) Are antidepressants safe in the treatment of bipolar depression? A critical evaluation of their potential risk to induce switch into mania or cycle acceleration. Acta Psychiatrica Scandinavica 118:5, 337-346
CrossRef140
Terence A. Ketter, John O. Brooks, Jennifer C. Hoblyn, Laurel M. Champion, Jennifer Y. Nam, Jenifer L. Culver, Wendy K. Marsh, Julie C. Bonner. (2008) Effectiveness of lamotrigine in bipolar disorder in a clinical setting. Journal of Psychiatric Research 43:1, 13-23
CrossRef141
Konstantinos N. Fountoulakis, Eduard Vieta. (2008) Treatment of bipolar disorder: a systematic review of available data and clinical perspectives. The International Journal of Neuropsychopharmacology 11:07,
CrossRef142
Eduard Vieta. (2008) Antidepressants in bipolar depression. Acta Psychiatrica Scandinavica 118:5, 335-336
CrossRef143
S. N. Ghaemi, A. P. Wingo, M. A. Filkowski, R. J. Baldessarini. (2008) Long-term antidepressant treatment in bipolar disorder: meta-analyses of benefits and risks. Acta Psychiatrica Scandinavica 118:5, 347-356
CrossRef144
Sinikka Sihvo, Erkki Isometsä, Olli Kiviruusu, Juha Hämäläinen, Jaana Suvisaari, Jonna Perälä, Sami Pirkola, Samuli Saarni, Jouko Lönnqvist. (2008) Antidepressant utilisation patterns and determinants of short-term and non-psychiatric use in the Finnish general adult population. Journal of Affective Disorders 110:1-2, 94-105
CrossRef145
Michael Berk, David L. Copolov, Olivia Dean, Kristy Lu, Sue Jeavons, Ian Schapkaitz, Murray Anderson-Hunt, Ashley I. Bush. (2008) N-Acetyl Cysteine for Depressive Symptoms in Bipolar Disorder—A Double-Blind Randomized Placebo-Controlled Trial. Biological Psychiatry 64:6, 468-475
CrossRef146
Niels H Jensen, Ramona M Rodriguiz, Marc G Caron, William C Wetsel, Richard B Rothman, Bryan L Roth. (2008) N-Desalkylquetiapine, a Potent Norepinephrine Reuptake Inhibitor and Partial 5-HT1A Agonist, as a Putative Mediator of Quetiapine's Antidepressant Activity. Neuropsychopharmacology 33:10, 2303-2312
CrossRef147
Robert T. Dunn, Vanessa A. Stan, Lyvia S. Chriki, Megan M. Filkowski, S. Nassir Ghaemi. (2008) A prospective, open-label study of Aripiprazole mono- and adjunctive treatment in acute bipolar depression. Journal of Affective Disorders 110:1-2, 70-74
CrossRef148
Anabel Martinez-Arn, Eduard Vieta, KN Roy Chengappa, Samuel Gershon, Jamie Mullen, Bjrn Paulsson. (2008) Reporting outcomes in clinical trials for bipolar disorder: a commentary and suggestions for change. Bipolar Disorders 10:5, 566-579
CrossRef149
Cabot, Richard C.Harris, Nancy Lee, Shepard, Jo-Anne O., Rosenberg, Eric S., Cort, Alice M., Ebeling, Sally H.Peters, Christine C., Viguera, Adele C., Emmerich, Anne D., Cohen, Lee S., . (2008) Case 24-2008. New England Journal of Medicine 359:5, 509-515
Full Text150
Guy M. Goodwin, Ian Anderson, Celso Arango, Charles L. Bowden, Chantal Henry, Philip B. Mitchell, Willem A. Nolen, Eduard Vieta, Hans-Ulrich Wittchen. (2008) ECNP consensus meeting. Bipolar depression. Nice, March 2007. European Neuropsychopharmacology 18:7, 535-549
CrossRef151
Zhang-Jin Zhang, Qing-Rong Tan, Yao Tong, Qiang Li, Wan-Hu Kang, Xue-Chu Zhen, Robert M. Post. (2008) The effectiveness of carbamazepine in unipolar depression: A double-blind, randomized, placebo-controlled study. Journal of Affective Disorders 109:1-2, 91-97
CrossRef152
Jan Fawcett. (2008) What We Have Learned from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) Study. Psychiatric Annals 38:7, 450-456
CrossRef153
Konstantinos N. Fountoulakis, Heinz Grunze, Panagiotis Panagiotidis, George Kaprinis. (2008) Treatment of bipolar depression: An update. Journal of Affective Disorders 109:1-2, 21-34
CrossRef154
Carlos A. Zarate, Husseini K. Manji. (2008) Bipolar disorder: candidate drug targets. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 75:3, 226-247
CrossRef155
James W Jefferson. (2008) Bupropion extended-release for depressive disorders. Expert Review of Neurotherapeutics 8:5, 715-722
CrossRef156
Ho-Joo Lee, Renee N. Ertley, Stanley I. Rapoport, Richard P. Bazinet, Jagadeesh S. Rao. (2008) Chronic Administration of Lamotrigine Downregulates COX-2 mRNA and Protein in Rat Frontal Cortex. Neurochemical Research 33:5, 861-866
CrossRef157
Michael E. Thase, Timothey Denko. (2008) Pharmacotherapy of Mood Disorders. Annual Review of Clinical Psychology 4:1, 53-91
CrossRef158
Jeffrey L. Cummings. (2008) Progress in Neurotherapeutics and Neuropsychopharmacology 2008. Progress in Neurotherapeutics and Neuropsychopharmacology 3:01,
CrossRef159
Fabiano G. Nery, Emel S. Monkul, John P. Hatch, Manoela Fonseca, Giovana B. Zunta-Soares, Benício N. Frey, Charles L. Bowden, Jair C. Soares. (2008) Celecoxib as an adjunct in the treatment of depressive or mixed episodes of bipolar disorder: a double-blind, randomized, placebo-controlled study. Human Psychopharmacology: Clinical and Experimental 23:2, 87-94
CrossRef160
Eduard Vieta, Trisha Suppes. (2008) Bipolar II disorder: arguments for and against a distinct diagnostic entity. Bipolar Disorders 10:1p2, 163-178
CrossRef161
Roger S. McIntyre, David J. Muzina, David E. Kemp, Diana Blank, Hanna O. Woldeyohannes, Jodi Lofchy, Joanna K. Soczynska, Suman Banik, Jakub Z. Konarski. (2008) Bipolar disorder and suicide: Research synthesis and clinical translation. Current Psychiatry Reports 10:1, 66-72
CrossRef162
Franco Benazzi. (2008) A tetrachoric factor analysis validation of mixed depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry 32:1, 186-192
CrossRef163
Michael E. Thase. (2007) Treatment of refractory bipolar depression. Current Psychiatry Reports 9:6, 495-496
CrossRef164
Anna Wirz-Justice. (2007) Chronobiology and psychiatry. Sleep Medicine Reviews 11:6, 423-427
CrossRef165
Michael E. Thase. (2007) STEP-BD and bipolar depression: What have we learned?. Current Psychiatry Reports 9:6, 497-503
CrossRef166
Brent M. McGrath, Andrew J. Greenshaw, Ryan McKay, Carolyn M. Slupsky, Peter H. Silverstone. (2007) Unlike lithium, anticonvulsants and antidepressants do not alter rat brain myo-inositol. NeuroReport 18:15, 1595-1598
CrossRef167
David J. Muzina. (2007) Bipolar Spectrum Disorder: Differential Diagnosis and Treatment. Primary Care: Clinics in Office Practice 34:3, 521-550
CrossRef168
(2007) Adjunctive Antidepressant Treatment for Bipolar Depression. New England Journal of Medicine 357:6, 614-616
Full Text169
Timothey C Denko, Michael E Thase. (2007) Bipolar disorder pharmacotherapy. Future Neurology 2:4, 441-450
CrossRef170
Belmaker, R.H., . (2007) Treatment of Bipolar Depression. New England Journal of Medicine 356:17, 1771-1773
Full Text171
Franco Benazzi. (2007) Bipolar II Disorder. CNS Drugs 21:9, 727-740
CrossRef
- Letters
