Journal of affective disorders
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Delayed onset of efficacy of antidepressants and a high proportion of depressed patients being poor or non-responders to antidepressants are well known clinical challenges. Therefore, it seems to be necessary to identify predictors for response and - even more important - for remission. It has been suggested that reduction of depressive symptoms at an early stage of antidepressant treatment may predict treatment outcome. Our objective was to test, if this hypothesis derived from randomized controlled studies (RCTs) in outpatients, would be confirmed in a large naturalistic study in a cohort of inpatients with major depression. Patients were treated with various antidepressants and co-medication according to the protocol based on evidence-based clinical guidelines. ⋯ The results support earlier findings that early improvement in the first two weeks may predict with high sensitivity later response and remission, even in hospitalized patients suffering from a more severe degree of depression. Since we used a naturalistic study design, the data may be considered as a replication of previous results drawn from RCTs in a naturalistic environment. We found a global antidepressant effect which was consistent across treatment subgroups regarding sensitivity values. However, we are aware of the inability of effectiveness studies to draw causal treatment relationships from the uncontrolled approach. Nevertheless, the replication of previous results might indicate that a drug switch during treatment in case of lack of early improvement could be accelerated.
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Comparative Study
The relationship of bulimia and anorexia nervosa with bipolar disorder and its temperamental foundations.
Earlier studies have suggested a relationship between bipolar disorder (BP) and eating disorders (ED), more specifically, bulimia nervosa (BN) and bipolar II disorder (BP-II). In the present report we extend this relationship to broader definitions of bipolarity. ⋯ In line with previous reports we describe an association between bulimia nervosa and bipolar disorder. Furthermore we report a relationship between lifetime bulimia and anorexia and cyclothymic and related affective temperaments.
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Multicenter Study
A prospective study of the impact of comorbid medical disease on bipolar disorder outcomes.
Several studies suggest that medical comorbidity is associated with worse clinical status in bipolar disorder. It is unclear which aspect of medical comorbidity is responsible: simple disease count, risk for future morbidity, or current physical burden. ⋯ This long-term prospective study extends cross-sectional and retrospective research on the link between medical illness and bipolar outcomes. It is the current experience of burden of physical illness, rather than an unweighted or weighted disease count, that leads to worse bipolar outcomes.
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Randomized Controlled Trial
Randomized, placebo-controlled trial of risperidone for acute treatment of bipolar anxiety.
The treatment of bipolar disorder is often complicated by the presence of a co-occuring anxiety disorder. Although second generation antipsychotics are being used with increasing frequency in bipolar patients, their anxiolytic effects have not been well studied in this population. ⋯ Risperidone monotherapy was not an effective anxiolytic for bipolar patients with comorbid panic disorder or GAD in doses of 0.5-4 mg/day over 8 weeks of treatment. The efficacy of other second generation antipsychotics and mood stabilizers on anxiety in patients with bipolar disorder and a co-occuring anxiety disorder should be investigated in double-blind, placebo-controlled studies.