Combination Therapy Better Than Leading Drug for Bipolar Disorder, Study Suggests

People with bipolar disorder are less likely to suffer a relapse if they are taking both lithium and sodium valproate rather than the drug valproate alone, an Oxford University study has shown.

Sodium valproate (available as Depakote) has been increasingly prescribed over lithium (Priadel) as a long-term therapy for bipolar disorder, particularly in North America. But the findings of the randomised trial, published in the medical journal The Lancet, suggest that those who have been prescribed valproate would fare better if lithium was added to their therapy, or if they changed to lithium alone.
'Our study indicates that a combination therapy of lithium plus valproate may be preferable for people with bipolar disorder over valproate alone, as there were significantly fewer relapses among those on both drugs over the two year period of the trial,' says Professor John Geddes of the Department of Psychiatry at the University of Oxford, who led the research.
About 1 in 100 people are diagnosed as having bipolar disorder (also known as manic depression), a mood disorder characterised by swings in a person's mood, including depression and mania. During a severe depressive episode, people may have feelings of hopelessness and despair, and have difficulty in carrying on with daily activities and work. In the manic phase, people may be overactive, lose judgement, become sexually uninhibited, and have grandiose ideas or delusions.

READ MORE @ SCIENCE DAILY

Widespread Generic Erosion of Atypical Antipsychotics Will Cause the Bipolar Disorder Drug Market to Decline By More Than $1 Billion Through 2018

Decision Resources, one of the world's
leading research and advisory firms for pharmaceutical and healthcare issues,
finds that widespread generic erosion of branded atypical antipsychotics will
cause the bipolar disorder drug market to decline from $6.3 billion in 2008 to
approximately $5 billion in 2018 in the United States, France, Germany, Italy,
Spain, the United Kingdom and Japan.

The new Pharmacor report entitled Bipolar Disorder finds that the market will
be constrained over the next several years by the patent expiries and
subsequent generic erosion of key antipsychotic agents such as AstraZeneca's
Seroquel, Eli Lilly's Zyprexa, Bristol-Myers Squibb/Otsuka's Abilify and
Pfizer's Geodon. In 2008, sales of atypical antipsychotics exceeded $4 billion
but generic competition, beginning in 2011, will cause sales of these agents
to decline to just under $3 billion by 2018, according to the report.
Additionally, patent expiries of branded antidepressants that include Wyeth's
(now Pfizer's) Effexor XR, Eli Lilly's Cymbalta/Xeristar and Forest/Lundbeck's
Lexapro/Cipralex will further constrain the market.

READ MORE @ REUTERS

Bipolar Disorder Amongst Children And Adolescents Receive Late Diagnosis

A new study finds that 75% of the cases of paediatric bipolar disorder are diagnosed late – up to 18 months – due to the symptoms manifesting themselves in a different manner depending on whether the patient is a child or adult. Moreover, 25% of sufferers have a delay in their medical diagnoses of up to three years and four months, according to a study by the Department of Psychiatry and Medical Psychology at the University Hospital of Navarra, in collaboration with the Paediatric Psychopharmacology Unit at the Massachusetts General Hospital at Harvard University (Boston, United States).

As Dr. Inmaculada Escamilla Canales, specialist at the Madrid-based Child and Adolescent Psychiatry Unit of the University Hospital of Navarra explained, the research was based on an article previously published by her department in 2005 in which the perspectives of bipolar disorder amongst children outside the USA were reviewed. A very low incidence was observed in Europe compared to the North American samples, especially amongst certain countries. Also, in Great Britain, a study undertaken with a sufficiently representative sample concluded that the rate for this illness was non-existent.

READ MORE @ SCIENCE DAILY

Schering-Plough Gets FDA Approval for Saphris

Schering-Plough Corp.'s new drug for schizophrenia and bipolar disorder, Saphris, has been approved by the Food and Drug Administration.

The pill, taken twice a day, is the first mind-altering medication to get simultaneous approval for treating both conditions, but it will face significant competition in a crowded market.

For now, it is only specifically approved for short-term use for acute problems, such as when patients have a psychotic episode. However, the drug's label, or detailed package insert, recommends patients responding well to Saphris should continue on it.

Kenilworth, N.J.-based Schering-Plough has completed some studies and is finishing up others on the long-term safety and effectiveness of the drug, spokesman Robert Consalvo said Friday. The company plans to eventually seek official approval for ''maintenance treatment.''

READ MORE @ NY TIMES

Some Conditions Misdiagnosed as Bipolar Disorder

A study published last year suggested that bipolar disorder may be over diagnosed in people seeking mental health care. Now new findings shed light on which disorders many of these patients actually have.

Bipolar disorder, also known as manic depression, involves dramatic swings in mood -- ranging from debilitating depression to euphoric recklessness.

In the original 2008 study, researchers at Brown University School of Medicine found that of 145 adults who said they had been diagnosed with bipolar disorder, 82 (57 percent) turned out not to have the condition when given a comprehensive diagnostic interview.

In this latest study, published in the Journal of Clinical Psychiatry, the researchers used similar standardized interviews to find out which disorders those 82 patients might have.

Overall, they found, nearly half had major depression, while borderline personality disorder, post-traumatic stress disorder (PTSD), generalized anxiety and social phobia were each diagnosed in roughly one-quarter to one-third.

READ MORE @ ABC NEWS

UPDATE 1-US FDA staff: Schering's antipsychotic works

Schering-Plough Corp's (SGP.N) experimental antipsychotic drug Saphris appears to be effective and as safe as other similar medications, U.S. Food and Drug Administration staff said in a memo released on Tuesday.

The drugmaker, which is expected to be acquired by Merck & Co Inc (MRK.N) later this year, is seeking FDA approval of the drug to treat adults with acute schizophrenia or bipolar disorder.

It has touted Saphris, or asenapine, as one of its five "star" products with the potential to earn more than $1 billion a year.

Although no final conclusion has been made, "we generally are in agreement that the sponsor has provided adequate support to suggest effectiveness for asenapine for the claimed indications," Dr. Thomas Laughren, director of the FDA's Division of Psychiatry Products, wrote in a June 24 memo.

Additionally, the drug's safety profile was "acceptable" and appears to be "qualitatively similar to that observed for other atypical antipsychotic drugs," he wrote.

READ MORE @ REUTERS

Treatment-Resistant Bipolar Disorder - A Review of Psychotherapeutic Approaches

The concept of treatment resistance in bipolar disorder is clinically familiar but lacks a standard definition.1 Whether the term refers to nonresponse to 1 or more standard treatments, at what dosages, and for what phases of bipolar disorder is unclear. Treatment resistance in bipolar disorder should always be based on a specific phase of treatment: mania or depression and acute or maintenance.

Treatment resistance is extremely common. Even under optimal maintenance conditions, almost half of bipolar patients with symptom remission will have a recurrence in 2 years under standard care (including medication combinations).2

Optimizing phase-specific , s is crucial. This may include raising the dosage of an initial treatment according to response unless limited by adverse effects. Acute treatments are often continued into maintenance. Combinations are commonplace, and the number of potential combinations is large. Decisions about which medications to use first or in what combinations, as well as dosing issues, require good clinical judgment on the part of each clinician because there is little evidence to drive such decisions.

READ MORE @ PSYCHIATRIC TIMES

Schizophrenia genetically linked to other psychiatric disorders

A huge international study has discovered the first common genetic mutations involved in schizophrenia. The results show that schizophrenia shares some genetic links with other psychiatric problems, including bipolar disorder.

Three research consortia analysed the DNA of 15,000 people with schizophrenia and 50,000 health control subjects, to find differences between those with and without the disease. Their findings are published in Nature, the journal

Schizophrenia, which affects about 1 per cent of adults, tends to run in families. This tripartite study has uncovered a vast array of genetic variation that is estimated to account for about a third of the disease's total heritability.

"Each individual gene has a small effect, raising the [risk] of schizophrenia from 1 per cent to 1.2 per cent at most," said David Collier, of the Institute of Psychiatry, London.

While the findings do not provide any astonishing revelations, the international collaboration has been a "spectacular success", according to Dr Collier. It will lead soon to a better understanding of the biology of schizophrenia, though new diagnostic tests and treatments lie further in the future.

READ MORE @ FINANCIAL TIMES

Bipolar patients often relapse: study

Results of a study suggest that bipolar disorder has a high relapse rate. In the study, researchers found evidence that three fourths of the hospitalizations for treatment of bipolar disorder are repeat admissions.

The study findings were reported today at the American Psychiatric Association's annual meeting in San Francisco.

Bipolar disorder, also known as manic depression, typically causes wide swings in mood -- sometimes from extreme incapacitating depression to euphoric recklessness.

"It is well known that bipolar disorder is a recurrent disease, so we considered it important to assess hospitalization patterns as an indication of the course of illness," principal investigator Dr. Urban sby from Danderyd University Hospital, Sweden, told Reuters Health prior to his presentation.

READ MORE @ REUTERS

Mental illness 'link to parents'

Children of bipolar parents have a 13-fold increased chance of suffering the same problem or other psychiatric disorders themselves, a study has shown.

A team of psychiatrists assessed two groups of children aged six to 18 for signs of bipolar disorder - formally known as manic depression - or other problems such as mood or anxiety disorders.

One group of 388 children had mothers or fathers with bipolar disorder. The other group of 251 had parents with no mental health problems.

A total of 10.6% of children with bipolar parents were positively tested for bipolar disorder or mood and anxiety disorders. In comparison, just 0.8% of children of mentally healthy parents had psychiatric conditions.

READ MORE @ PRESS ASSOCIATION

Bipolar disorder increases risk of disease

Bipolar disorder, like smoking, increases the risk of early death from medical illnesses, a U.S. review found.

The review of 17 studies, published in Psychiatric Services, involving more than 331,000 patients suggested that people with bipolar disorder have a higher mortality from natural causes compared with people in the general population of similar age and gender but without mental illness.

"The review of data gathered from large population studies suggests that having bipolar disorder is similar to being a smoker in terms of increasing a person's risk of early death," Dr. Wayne Katon of the University of Washington in Seattle, co-author of the review, said in a statement.

People with bipolar disorder tend to have both manic phases that can include sleepless periods and depressed phases that can even leave them immobilized. There are many possible factors that may account for the higher risk of premature death.

READ MORE @ UPI

Manic Symptoms in Bipolar Depression Linked to Drug-Induced Mood Cycling

Patients with bipolar disorder who are on antidepressants may be at increased risk of rapid mood switches when even minimal manic symptoms are present, researchers found.

Bipolar patients with even low scores for symptoms of racing thoughts, distractibility, psychomotor agitation, and pressured speech were significantly more likely to develop treatment-emergent mania when started on antidepressants, Mark A. Frye, M.D., of the Mayo Clinic here, and colleagues reported in the February issue of the American Journal of Psychiatry.

These findings are the first prospective, controlled data supporting heightened risk of mood cycling and add to mounting evidence against antidepressants in bipolar disorder, noted Christopher D. Schneck, M.D., of the University of Colorado, in an accompanying editorial.

By re-emphasizing the importance of evaluating these symptoms, he wrote, "clinicians may be able to better predict which patients have an underlying bipolar diathesis and thereby avoid giving them antidepressants."

READ MORE @ MEDPAGE TODAY

Bipolar Disorder Linked to Higher Mortality from Medical Illnesses

Bipolar disorders appear to increase the risk of early death from a medical illness, according to a literature review study published as the lead article this week in the journal Psychiatric Services.

The researchers comprehensively reviewed 17 studies involving more than 331,000 patients. Evidence suggested that people with bipolar disorder have a higher mortality from natural causes compared to people in the general population of similar age and gender but without mental illness. The various studies indicated that the risk was from 35 percent to 200 percent higher. The risk is the same for men and women. The most common conditions leading to premature death were heart disease, respiratory diseases, stroke, and endocrine problems such as diabetes.

"The review of data gathered from large population studies suggests that having bipolar disorder is similar to being a smoker in terms of increasing a person's risk of early death," said Dr. Wayne Katon, a University of Washington (UW) professor of psychiatry. He co-authored the study with third-year UW psychiatry resident Babak Roshanaei-Moghaddam. The article is titled, "Premature Mortality from General Medical Illnesses Among Persons with Bipolar Disorder: A Review." Katon is a noted researcher on the interplay between life-shortening medical conditions and mood disorders.

People with bipolar disorder tend to have manic phases and depressed phases in their lives. During mania, they might be too wound up to sleep, their thoughts might race, and they might have boundless energy. During depression, they might feel painfully sad, hopeless, and immobilized.

READ MORE @ NEWSWISE

New study: Bipolar disorder and schizophrenia are genetically linked

A new study suggests that if schizophrenia runs in a family, there's a good chance that bipolar disorder does as well (and vice versa). The findings, published today in the journal The Lancet, suggest that the two disorders are caused by some of the same genes.

"These findings say that [schizophrenia and bipolar disorder] are related, above all, for genetic reasons," says lead study author Paul Lichtenstein, a genetic epidemiologist at the Karolinska Institutet in Stockholm, Sweden. "[Therefore] it might not be a good idea to view these disorders as separate entities."

Lichtenstein and his colleagues (researchers from both the U.S. and Sweden) scoured the entire Swedish population for anyone with schizophrenia or bipolar disorder by reviewing psychiatric discharge data from all Swedish hospitals between 1973 and 2004.

READ MORE @ SCIENTIFIC AMERICAN

SEROQUEL XR™ And SEROQUEL(R) Approved In Europe For New Indications For The Treatment Of Bipolar Disorder

AstraZeneca today announced that the once-daily formulation SEROQUEL XR™ (quetiapine fumarate extended release tablets) and SEROQUEL® (quetiapine fumarate) have been approved via the Mutual Recognition Procedure for new indications in bipolar disorder. SEROQUEL XR and SEROQUEL have been approved for treatment of major depressive episodes in bipolar disorder. Additionally, SEROQUEL XR has been approved for treatment of moderate to severe manic episodes in bipolar disorder.

This follows the October 2008 approval of SEROQUEL XR in similar indications by the U.S. Food and Drug Administration (FDA). As a result of these new indications for adult patients, SEROQUEL (both formulations) is currently the only atypical antipsychotic approved to treat the spectrum of mood episodes associated with bipolar disorder and the only licensed treatment for bipolar depression in the EU. The mechanism of action of SEROQUEL, which involves both antipsychotic and antidepressant activities, may help explain its unique efficacy across the spectrum of mood episodes associated with bipolar disorder.

READ MORE @ MEDICAL NEWS TODAY

Increased Bipolar Risk Linked to Father's Age

Older men are more likely than younger men to father children with autism, schizophrenia, or early-onset bipolar disorder.

Fathering a child later in life seems to increase its risk of having autism or schizophrenia, research has shown. And now it seems to increase a child's risk of having bipolar disorder as well, a new study suggests.

The study was headed by Emma Frans, a doctoral student in epidemiology at the Karolinska Institute in Stockholm. Results were published in the September Archives of General Psychiatry.

Sweden's Multigeneration Register, as well as Sweden's National Hospital Discharge Register, made this new investigation possible. The former, which has been in existence since 1947, gives demographic information about all people living in Sweden as well as about their parents. The latter, which has been in existence since 1973, lists all people living in Sweden who have been hospitalized for various conditions.

READ MORE @ PSYCHIATRIC NEWS

U.S. Kids Take More Psychotropic Drugs Than Europeans

American children are three times more likely to be prescribed psychotropic medications for conditions such as ADHD and bipolar disease than European children are, a new study finds.

Differences in regulatory practices and cultural beliefs about the benefit of medication for emotional and behavioral problems may explain this dramatic difference, the U.S. researchers added.

"There is significantly greater use of atypical antipsychotics and SSRI-type antidepressants for child mental health treatment in U.S. than in Western Europe," said lead researcher Julie Zito, from the pharmaceutical health services research department in the School of Pharmacy at the University of Maryland. "Since most of the use is 'off-label' -- without adequate evidence of benefits and risks, close monitoring should be considered when these medications are used."

The report was published in the Sept. 24 online edition of Child and Adolescent Psychiatry and Mental Health.

READ MORE @ FORBES

The Bipolar Puzzle

When Claire, a pixie-faced 6-year-old in a school uniform, heard her older brother, James, enter the family’s Manhattan apartment, she shut her bedroom door and began barricading it so swiftly and methodically that at first I didn’t understand what she was doing. She slid a basket of toys in front of the closed door, then added a wagon and a stroller laden with dolls. She hugged a small stuffed Pegasus to her chest. “Pega always protects me,” she said softly. “Pega, guard the door.”

James, then 10, had been given a diagnosis of bipolar disorder two years earlier. He was attending a therapeutic day school in another borough and riding more than an hour each way on a school bus, so he came home after Claire. Until James’s arrival that April afternoon, Claire was showing me sketches she had drawn of her Uglydolls and chatting about the Web site JibJab, where she likes to watch goofy videos. At the sound of James’s footsteps outside her bedroom door, she flattened herself behind the barricade. There was a sharp knock. After a few seconds, James’s angry, wounded voice barked, “Forget it,” and the steps retreated.

READ MORE @ NY TIMES

Astonishing 52 Percent of Newly Diagnosed Bipolar Disorder Patients Receive Antidepressant Drugs in First-Line Treatment

Lamictal is the Leading Single-Agent in First-, Second- and Third-Line Therapy, According to a New Report from Decision Resources

Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that an astonishing 52.3 percent of newly diagnosed bipolar disorder patients are prescribed antidepressant drugs first line. The new report entitled Treatment Algorithms in Bipolar Disorder finds that this high preponderance of early-line antidepressant use stems from primary care physician prescribing. Surveyed primary care physicians specify selective serotonin reuptake inhibitors (including Forest Laboratories' Lexapro) as a favored first-line treatment choice for patients with bipolar disorder I with acute depression (51 percent of surveyed physicians), bipolar disorder II with acute depression without hypomania (52 percent of surveyed physicians) and bipolar disorder II with acute depression with hypomania (46 percent of surveyed physicians).
"The number of primary care physicians who are diagnosing and treating bipolar patients has been on the rise in the past few years, but surveyed primary care physicians follow a very different treatment pattern than surveyed psychiatrists," said Madhuri Borde, Ph.D., analyst at Decision Resources. "Nearly half of the patients taking selective serotonin reuptake inhibitors first line receive these drugs as a monotherapy, despite guideline recommendations to give bipolar patients presenting with depression an antimanic first line."

READ MORE @ MARKET WATCH

Generic Med for Bipolar

Generic versions of Risperdal (risperidone) tablets have been approved by the U.S. Food and Drug Administration for treatment of schizophrenia, bipolar disorder, and other psychiatric conditions.

“This generic drug approval is another example of the FDA’s efforts to increase access to safe and effective generic drugs as soon as the law permits,” said Gary Buehler, director of the FDA’s Office of Generic Drugs in the Center for Drug Evaluation and Research.

Varying strengths of risperidone tablets, manufactured by TEVA Pharmaceuticals USA, have been approved.

The labeling of the generic risperidone may differ from that of Risperdal because some uses of the drug are protected by patents and exclusivity.

READ MORE @ PSYCHCENTRAL