Bipolar Disorder Daily News Blog

AstraZeneca today launched its once-daily SEROQUEL XR (quetiapine fumarate) Extended-Release Tablets for the acute treatment of the depressive episodes associated with bipolar disorder and the manic and mixed episodes associated with bipolar I disorder, as well as the maintenance treatment of bipolar I disorder as adjunctive therapy to lithium or divalproex. SEROQUEL XR is also now available in two new tablet strengths, 50-mg and 150-mg.

Once-daily SEROQUEL XR is the only medication FDA-approved for the treatment of acute depressive, manic, and mixed episodes of bipolar disorder.

"Bipolar depression is a serious and debilitating illness with few approved treatment options," said Dr. Trisha Suppes, Professor of Psychiatry and Behavioral Sciences, Medical Center and VA Palo Alto Health Care System. "People with bipolar disorder are known to struggle more frequently with the depressive rather than the manic symptoms. SEROQUEL XR has been shown to be effective as a monotherapy in treating bipolar depressive symptoms, such as sadness, loss of interest, and feelings of worthlessness."

"When symptomatic, people with bipolar disorder experience depressive symptoms more than three times longer than manic symptoms, and this may interfere with daily activities," said Dr. Arthur Lazarus, Senior Director, Clinical Development for AstraZeneca. "The approval of SEROQUEL XR for the treatment of bipolar disorder provides patients with the only medication that has been proven to treat the acute depressive, manic, and mixed episodes of bipolar disorder."

Today's announcement follows the October 2008 FDA approval of SEROQUEL XR for these indications in bipolar disorder.

Most new drugs that are used in treatment for schizophrenia have also been found to be helpful in bipolar disorder, and have been approved for use in treatment of bipolar disorder. Wired magazine writes about a series of new drugs that are in the research phase and may (if they prove effective) eventually be used in treatment for schizophrenia and bipolar disorder.

Read the story: Angel Dust Inspired a new Schizophrenia Drug

There is a fascinating interview with Nancy Andreasen, a leading brain researcher, in today's New York Times. In the interview she discusses her research she's been doing for the past 18 years and which is not yet published. Much of her research is related to schizophrenia, but because schizophrenia is thought to have a lot of genetic overlap with bipolar disorder - her research may also be relevant to bipolar disorder.

In it she notes "The big finding is that people with schizophrenia are losing brain tissue at a more rapid rate than healthy people of comparable age. Some are losing as much as 1 percent per year. That’s an awful lot over an 18-year period."

In response to this interview - researchers have made the following comment:

Re “A Conversation With Nancy C. Andreasen” (Sept. 16): We have to express concern about Dr. Andreasen’s comments on the loss of brain tissue in individuals with schizophrenia.

She implies that such loss is caused by antipsychotic drugs despite the fact that it was clearly described before such drugs became available. The fact that “the more drugs you’ve been given, the more brain tissue you lose” may be explained by the fact that individuals with more severe schizophrenia are given more drugs.

We are particularly concerned that the studies that she cites have not been subject to the process of peer review. Your readers should be cautioned not to accept findings in complex disorders such as schizophrenia until they are subject to scientific scrutiny.

Robert Yolken, M.D.
Baltimore

E. Fuller Torrey, M.D.
Chevy Chase, Md.
Dr. Yolken is a professor of pediatrics at Johns Hopkins School of Medicine, and Dr. Torrey is executive director of the Stanley Medical Research Institute in Gaithersburg, Md.

Read the interview: Using Imaging to Look at Changes in the Brain

This morning the Wall Street Journal covers the recent analysis of the health-care proposals of the McCain and Obama campaigns. Health-care coverage is, of course, a huge issue for families where a child or spouse has bipolar disorder and all the associated high costs of in and out-patient treatment. Many people who have bipolar disorder have a difficult time maintaining consistent employment so may not have employer health insurance benefits on an ongoing basis. For this reason, we recommend you study the proposals of each of the candidates closely.

The WSJ notes:

"Republican presidential candidate John McCain's health-care plan would make only a small dent in the ranks of the uninsured, at best covering about five million more people, two new reports conclude.

Democratic nominee Barack Obama would cover more people -- eventually adding about 34 million, according to one of those reports, by the nonpartisan Tax Policy Center.

Sen. Obama's plan would be costly, the center concluded: $1.6 trillion over 10 years. Sen. McCain's would cost nearly as much: $1.3 trillion over the same span. The center doesn't give either campaign credit for initiatives to reduce the cost of health care."

Read the full story at the Wall Street Journal: Studies Detail Contrasts in Rivals' Health-Care Plans

A new study by the National Institute of Mental Health suggests that two newer atypical antipsychotic medications were no more effective than an older conventional antipsychotic in treating child and adolescent schizophrenia and may lead to more metabolic side effects. While this study focuses on the use of the medications in youth diagnosed with schizophrenia - frequently these same medications (Risperdal and Zyprexa) are also used in the treatment of adolescent bipolar disorder.

“Schizophrenia and schizophrenia-related disorders are rare in childhood. But when they do occur, those afflicted generally have more severe symptoms and a worse prognosis than those who develop the disorder in adulthood,” said NIMH Director Thomas R. Insel, M.D. “The newer atypical antipsychotics are often used to treat these children, but until now, it has been unclear how effective and safe they really are in children. The side effects of the newer medications should be factored into making treatment decisions.”

The six-year, multisite Treatment of Early Onset Schizophrenia Study (TEOSS) included 116 youth between 8 and 19 years old, diagnosed with early onset schizophrenia spectrum disorder (EOSS). The TEOSS team randomly assigned the children to eight weeks of either olanzapine (Zyprexa) or risperidone (Risperdal)—both new generation atypical antipsychotics—or to the older conventional antipsychotic molindone (Moban) plus benztropine, a medication often used to reduce side effects like uncontrolled shaking or tremor that can be associated with molindone. The children were monitored throughout the study by an NIMH oversight board to ensure their safety.

Response rates after eight weeks of treatment were comparable among the three medications—50 percent of the children taking molindone improved, 46 percent taking risperidone improved, and 34 percent taking olanzapine improved. Children taking olanzapine or risperidone improved within the first two weeks, while the children on molindone improved within three weeks.

The treatment groups did differ in side effects. The children taking olanzapine gained about 13 pounds (6 kilograms) during the trial on average, while children taking risperidone gained about 8 pounds (3.6 kilograms), and those taking molindone did not gain weight. The olanzapine group also showed increases in cholesterol levels and other metabolic disruptions that may have become dangerous. The outcome prompted the safety review board to end the olanzapine arm of the study in 2006.

“Atypical antipsychotics are commonly used to treat kids with EOSS, but these results question the wisdom of that approach,” said lead author Linmarie Sikich, M.D., of the University of North Carolina at Chapel Hill. “They also remind us that we need to develop safer, more effective medications to treat these children, given the limited effectiveness of both the atypical and the conventional medications.”

Study coauthor Jeffery Lieberman, M.D., of Columbia University Medical Center, noted that TEOSS is the first documented evidence of how newer antipsychotics compare to older ones when treating children and adolescents with schizophrenia. “Doctors need to educate families about the potentially serious side effects these drugs can have so that strategies can be put into place to address them,” he reiterated. The TEOSS results are similar to those found in the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), for which Lieberman was the principal investigator. CATIE found that the newer antipsychotics were no more effective than an older antipsychotic in treating adults with schizophrenia.

TEOSS was conducted at the University of North Carolina at Chapel Hill, Harvard University, Seattle Children’s Hospital, and Case Western Reserve University.
Reference

Sikich L, Frazier JA, McClellan J, Findling RL, Vitiello B, Ritz L, Ambler D, Puglia M, Maloney AE, Hunt-Harrison T, Jackson JA, De Jong S, Slifka K, Noyes N, Michael E, Hlastala S, Pierson L, McNamara NK, Delporto-Bedoya D, Anderson R, Hamer RM, Lieberman JA. Comparative efficacy of antipsychotics in early onset schizophrenia. American Journal of Psychiatry

There is a good story that starts with one family's experience with childhood bipolar disorder in this week's New York Times magazine. The story chronicles the early life of "James" as he develops the disorder and eventually gets treatment.

Using that personal story as a background, the author then digs into the current controversies around the disorder and other families stories. Describing the issue that is around the exact frequency of bipolar disorder in children, the author notes:

"A study last fall measured a fortyfold increase in the number of doctor visits between 1994 and 2003 by children and adolescents said to have bipolar disorder, and the number has likely risen further. Most doctors I spoke with found the “fortyfold increase” misleading, since the number of bipolar kids at the beginning of the study was virtually zero and by the end of the study amounted to fewer than 7 percent of all mental-health disorders identified in children. Many also said that because bipolar children are often severely ill, they can proportionately account for more doctors’ visits than children with other psychiatric complaints, like A.D.H.D. or Anxiety Disorder. Still, nearly every clinician I spoke to said that bipolar illness is being overdiagnosed in kids. In Leibenluft’s studies at the National Institute of Mental Health, only 20 percent of children identified with bipolar disorder are found to meet the strict criteria for the disease.

Read the full story: The Bipolar Puzzle (New York Times)

Furious Seasons blog issued a rebuttal to the article here

Research over the past decade has clearly shown that children of older fathers have a higher risk for schizophrenia because their sperm is more likely to have damaged DNA in them due to the ravages of time. Now new research has identified the same risk for bipolar disorder - a disorder that is believed to be genetically and environmentally close to schizophrenia.

A new study by researchers at the Swedish medical university Karolinska Institute suggested that older age among fathers is associated with an increased risk for bipolar disorder in their offspring,.

Bipolar disorder is a common, severe mood disorder involving episodes of mania and depression. Other than a family history of psychotic disorders, few risk factors for the condition have been identified. Older paternal age has previously been associated with a higher risk of complex neurodevelopmental disorders, including schizophrenia and autism.

Postgraduate student Emma Frans and colleagues at the Department of Medical Epidemiology and Biostatics identified 13,428 patients in Swedish registers with a diagnosis of bipolar disorder. For each one, they randomly selected from the registers five controls who were the same sex and born the same year but did not have bipolar disorder.

When comparing the two groups, the older an individuals father, the more likely he or she was to have bipolar disorder. After adjusting for the age of the mother, participants with fathers older than 29 years had an increased risk. The offspring of men 55 years and older were 1.37 times more likely to be diagnosed as having bipolar disorder than the offspring of men aged 20 to 24 years.

The offspring of older mothers also had an increased risk, but it was less pronounced than the paternal effect, the authors note. For early-onset bipolar disorder (diagnosed before age 20), the effect of the father's age was much stronger and there was no association with the mother's age.

As men age, successive germ cell replications occur and new mutations accumulate monotonously as a result of DNA copy errors. Women are born with their full supply of eggs that have gone through only 23 replications, a number that does not change as they age. Therefore, DNA copy errors should not increase in number with maternal age.

Consistent with this notion, we found smaller effects of increased maternal age on the risk of bipolar disorder in the offspring, says Emma Frans.

Source: Advancing Paternal Age and Bipolar Disorder, Archives of General Psychiatry, 1 september 2008; 65[9]:1034-1040.

Two lead researchers in the area of geriatric bipolar disorder have written a book: Bipolar Disorder in Later Life, which is meant to help treat the increasing numbers of people afflicted with bipolar disorder in old age. The goal of the authors Martha Sajatovic from Case Western Reserve University and Frederic Blow from the University of Michigan, is to inform clinicians treating elderly bipolar disorder patients about new research in the field. For the book, Sajatovic and Blow asked for the participation of their peers in the field and according to a new review have produced a "... comprehensive, cohesive, and crisply written..." book. Though this book seems to be primarily for clinicians and researchers, we thought it important to mention it.

Complete Review of Book

We want to announce a short book of poems published recently by Vantage Press, Inc. The book titled, Soul: The Treasury of Anne-Patrice, consists of poetry written by author Anne-Patrice Whaley-Tandy. Whaley-Tandy suffers from bipolar disorder and though her poetry in this book focuses on spirituality, she covers other subjects as well, including poems about her psychiatrist, psychologist and children. Here are a few excerpts:

Nancy, Psychiatrist

Though I've known her just a
year
I come to her with no fear because
her questions pertain to not just
how are you mentally, but where
your life is leading actually.
. . .
It's difficult because when you are
in a hospital you have new doctors
you don't know at all
so it's important you bond with your doctor as an outpatient
and she with you---
there is so much you travel
together through.

Judith, Psychologist

Once upon a time you're
blessed
with someone unlike the rest
. . .
She has fought many years through
the cascade of my tears and never
criticized my wrongs

But led me gently laughing,
to aspire
to let my moral fibrer lead and
not give in to devastation . . .

Related Stories:
Creativity and Bipolar Disorder Correlated
Curing Oneself Through Writing

Researchers that sleep is connected to bipolar disorder. That is, past research has shown that bipolar patients have difficulty with sleep and often suffer from sleep-related problems. Now new research is showing that routine sleep schedules can actually be beneficial to the outcomes of bipolar disorder.

A new study which appears in this month's issue of the journal, American College of Neuropsychopharmacology (ANCP), examined two groups of adult bipolar patients receiving different treatment therapies and found that the group of patients who participated in interpersonal and rhythm therapies--these therapies involved the patients monitoring their daily routines--had longer periods without mania and depression. Researchers have believed for some time that bipolar disorder is greatly affected by the circadian rhythm or the body's internal clock, and these new findings only further support this idea.

It seems that sufferers of bipolar disorder tend to have more sensitive circadian systems than do others, and as a result, a change in routine or sleep schedule can throw the internal clocks of bipolar sufferers off (more so than with the healthy population), and result in more frequent manic and depressive episodes for bipolar patients.

Ellen Frank, Ph.D., who conducted the new study at the University of Pittsburgh School of Medicine had this to say about the findings:

Having already found that disruption in daily routines can make individuals with bipolar disorder vulnerable to new episodes of illness, we have now learned that working with patients to achieve and maintain regular social rhythms -- including regular sleep patterns and adequate physical activity -- will help to protect them against episodes of mania or depression, we have now learned that working with patients to achieve and maintain regular social rhythms -- including regular sleep patterns and adequate physical activity -- will help to protect them against episodes of mania or depression...

Full Article:Sleep helps in bipolar disorder treatment (United Press International)

Related Stories:
Dark Therapy: A Possible Treatment for Bipolar Disorder
Role of Serotonin in Modulating Circadian Rhythm

We recently covered a study which found that children suffering from bipolar disorder are more likely to misread facial expressions and experience certain moods such as irritability and excessive happiness. Now a new study, published in last month's issue of The Journal of Neuropsychiatry and Clinical Neurosciences, finds that the adults suffering from bipolar disorder are also prone to impaired emotional perception.

For the study, 19 patients suffering from bipolar disorder I and in remission were compared to 22 healthy individuals (both groups were matched for age, gender, education, etc.) . The participants were all given an Affective Prosody Test (APT). Taking this test usually means that participants listen to tapes where sentences expressing certain emotions are read (for example, the emotions: happy, sad, angry, etc.), and then asked to specify the emotions they believe were expressed. For this study, the researchers found that bipolar patients had "significantly lower scores on the APT" than did the other participants. In particular, female participants with bipolar disorder showed specific impairment in perceiving "certain emotions" for example: surprise and fear.

The sample size of this study was small, thus if it is repeated, the future results may be more generalizable. Nevertheless, the issue of impaired emotional perception for bipolar patients is an important one, not just because it enables outsiders to better understand the experience of bipolar sufferers but also because it may lead to newer, more effective treatments.

Impaired Perception of Affective Prosody in Remitted Patients With Bipolar Disorder Bozikas et al. J Neuropsychiatry Clin Neurosci.2007; 19: 436-440

Goodwin, Frederick K. and Jamison, Kay Redfield. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd Edition. Oxford University Press, USA. March 9, 2007

The long awaited Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition, by Frederick K. Goodwin and Kay Redfield Jamison is finally in stores.
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