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September 26, 2006
Australian Study Challenges Bipolar Disorder Treatment Conventions
An Australian research study has questioned the widespread practice of prescribing heavy duty anti-psychotic drugs to mild bipolar sufferers.
A study by Sydney's Black Dog Institute has made the controversial finding that new generation anti-depressants are a more effective treatment for the less severe but most common form of the mood disorder.
This is despite guidelines, in Australia and overseas, recommending doctors never prescribe the drugs - known as selective serotonin reuptake inhibitors (SSRIs) - to people with the condition.
Writing in the Journal of Affective Disorders, the researchers claim their work "potentially signals one of the most significant medical advances in many years in the treatment of a mental illness".
Almost five per cent of Australians have the less severe bipolar disorder two, experiencing dramatic swings from highs to depression but not psychotic episodes.
But medical guidelines for treatment of this condition don't differentiate it from the rarer but more severe form, known as bipolar one.
"Doctors don't have any guidelines so these people just get the same heavy duty mood stabilisers given to people with bipolar one," said the institute's executive director Professor Gordon Parker.
Compounding the problem, the guidelines specify never to use anti-depressants to treat a bipolar patient because it will flip people into a dangerous "manic high".
"So most clinicians have been scared off from ever using anti-depressants to a bipolar person in a depressed state, or they delay their use for weeks," Prof Parker said.
Instead they're given standard mood stabilisers like lithium and often anti-psychotic drugs as well.
"So for a lot of people, that means staying in their depressed state for weeks if they get the anti-depressants at all," he said.
The study, the first of its kind in the world, tracked ten patients over nine months.
"We found that the SSRIs don't cause anything like the manic switching that the mythology would suggest," Prof Parker said.
"But more importantly they came back saying their depression was better and they also had fewer highs that didn't last as long and were not so severe."
Given the small sample size, the academic said there was a need to conduct a larger study, but the initial research indicated the guidelines were incorrect.
"All the guidelines say you must not do this and we think that's completely wrong," he said.
"This challenges the prevailing guidelines around the world.
"It has huge potential because it's really saying that for people with bipolar two there's a treatment out there that isn't going to be as heavy duty as a mood stabiliser or an anti-psychotic drug."
Special thanks to Tim for identifying this story.
British Actor Stephen Fry Talks About his Bipolar Disorder
Stephen Fry - one of Britain's best-loved actors and comedians, spent years drinking vodka and taking cocaine to numb the internal anguish of his depression. ''I'm actually kind of sobbing and kind of tearing at the walls inside my own brain while my mouth is, you know, wittering away in some amusing fashion,'' he says. The 49-year-old actor has been tormented by mental illness for much of his life. But he has never before spoken of it with such candour. This week for the first time, in a program broadcast on BBC2, he bared his soul.
Fry had to wait until he was 37 before he was finally diagnosed with bipolar disorder, a condition characterised by soaring highs and despairing lows. Nobody saw it coming. Before his sensational collapse became headline news he was one of television's best-loved performers. He was at the height of his fame, after years of sustained success, yet everything came to an abrupt end in 1995 after he walked out from a starring role after just three shows of the West End play Cell Mates, which had suffered poor reviews.
Fry came close to gassing himself in his car. ''I had this image of my parents staring right in at me while I sat there for at least, I think, two hours in the car with my hands over the ignition key,'' he says. ''I decided not to do it. When you feel you can't go on - it's not just a phrase, it is a ... a reality. I could not go on, and I would have killed myself if I didn't have the option of disappearing because it was that absolute.'' He went missing in Europe for a week then returned to London and spent months having psychological treatment in the US. In the BBC2 documentary, The Secret Life of the Manic Depressive, he consults experts and fellow sufferers of bipolar disorder, including the comedian Tony Slattery and Hollywood actors Richard Dreyfuss and Carrie Fisher.
The illness, formerly known as manic depression, affects hundreds of thousands of people in the UK. Although it can be managed successfully with drug and psychological therapies, 15 per cent of sufferers - about 2000 people a year - kill themselves. Doctors estimate that one in 100 have bipolar disorder, but some researchers think the true figure could be far higher. Campaigners say only about half of sufferers are actually diagnosed and, on average, this can take eight years. The delay could be costing lives, Michelle Rowett says, the chief executive of MDF The BiPolar Organisation, a user-led charity. ''Bipolar has the highest suicide rate out of all mental illnesses,'' she says. ''So people not treated soon enough are having their lives put at risk.'' The disorder costs the country 2billion (A$5.04billion) a year.
At present, most sufferers do not receive optimal care, only 5 per cent have psychological therapy and just a third of known sufferers have a yearly check of their state of mind. Professor Nick Craddock, of Cardiff University, is conducting the world's largest study into bipolar disorder in an attempt to improve diagnosis and treatment. Findings being published this year will implicate several genes. ''Genes can make someone susceptible but external triggers will play a big role in determining whether that person goes on to develop bipolar disorder,'' he says. ''Several per cent of the population have a tendency to have bipolar mood swings.'' Fry fears the growing intensity of his attacks of depression and says he is ''in a very sort of black state'' but remains undecided about whether he needs medical treatment. ''I love my condition too. It's infuriating, I know, but I do get a huge buzz out of the manic side. I rely on it to give my life a sense of adventure, and I think most of the good about me has developed as a result of my mood swings. It's tormented me all my life with the deepest of depressions while giving me the energy and creativity that perhaps has made my career.'' -
Source: The Independent
September 5, 2006
New Treatment Model for Bipolar Disorder Shows Promise
A new care model for bipolar disorder tested in veterans across the nation reduced their manic episodes and improved their quality of life, according to a new research study.
Who did the study?
A new 3 year study, lead by Providence Veterans Affairs Medical center and Brown Medical School, on a new and cost effective treatment model for bipolar disorder was tested on over 300 veterans. The results of the study mirror a previous study published in the May 2006 issue of the Archives of General Psychology.
What was the study trying to do?
The new study provides an increase from 400+ particiants from the previous study, to a 700+ new total; which provides more validity and reliability to the results on this new treatment model.
"We applied the same symptom management approaches found in interventions for diabetes and asthma to the treatment of bipolar disorder and found that people with serious mental illness can help take control of their care,” said Mark S. Bauer, M.D., staff psychiatrist with the Providence V.A. Medical Center and professor of psychiatry and human behavior at Brown Medical School. “This finding should reduce the stigma of helplessness that so often is associated with these disorders, and it will open new avenues for the treatment of bipolar disorder.”Method
The study utilized a group which continued to receive the same typical treatment, while another group was treated with the new multicomponent intervention program. This new program consisted of a structured treatment team of nurses and psychiatrists. The patients had weekly group sessions where nurses “discussed topics such as medication side effects and early warning signs for symptoms, which in bipolar disorder range from racing speech, bursts of optimism and impulsive behavior during manic episodes to fatigue, social withdrawal and suicidal thoughts during depressive episodes.” This allowed the patients to receive peer support, and create tangible goals for themselves. The care also included “a structured group psychoeducational program, monthly telephone monitoring of mood symptoms and medication adherence, feedback to treating mental health providers, facilitation of appropriate follow-up care, and as-needed outreach and crisis intervention.”
The results where obtained by in-person blind interviewing and assessment every 3 months on mood, and severity of symptoms by means of a reliable longitudinal follow-up examine.
Though there were no significant changes between the new treatment group and the traditional in terms of depressive symptoms, there was a significant reduction in mania symptoms, as well as the amount of time the patients were affected by these mania symptoms. They found the new program reduced 5 weeks of mania during the 3 year study. “Patients also felt happier and healthier, reporting more productive time at work, better relationships with family, and more satisfaction with their care.”
Not only was the new program a success from a clinical standpoint, it was also cheaper than traditional methods being used right now.
“The new model was less expensive – an average of $61,398 for three years of direct treatment costs compared with $64,379 for usual care – although the difference was not statistically significant.”
Read Full Research Articles:
"Long-term Effectiveness and Cost of a Systematic Care Program for Bipolar Disorder" Archives of General Psychiatry. May 2006.
Read Press Article:
Accelerating the Hunt for Bipolar Disorder Genes
The two universities will combine research efforts on bipolar genetics - and combine their stockpiles of biological samples from bipolar patients and their families. They will then make the entire collection of samples available as a shared resource to researchers anywhere who are searching for clues to bipolar's inherited traits.
A total of 1,500 blood and cell samples from 140 families affected by bipolar disorder will be sent to Michigan from John Hopkins; DNA samples will be made for both labs to study.
The effort will greatly expand the Prechter Bipolar Genetics Repository, which since 2005 has been used by U-M researchers and colleagues at Stanford University and Cornell University. The Prechter Repository is funded by the U-M’s Heinz C. Prechter Bipolar Research Fund, founded by Waltraud "Wally" Prechter in an ongoing effort to conquer the disease that took her husband's life.
The new effort ultimately aims to improve diagnosis and treatment for bipolar patients and their family members. Specifically, research performed using Prechter Repository’s samples will help scientists understand which genetic variations make people susceptible to developing the disease, and what genetic characteristics tend to correlate with the severity of the disease or response to treatment over time.
University of Michigan Health System
Prechter Bipolar Genetic Repository
For more information on the Prechter Bipolar Genetics Repository, and the need for more patients and families to volunteer samples of their blood and DNA, call 1-877 UM-GENES
Read Full Press release:
September 1, 2006
Bipolar disorder takes twice depression's toll in workplace
Research Suggests that Productivity lags even after mood lifts
Bipolar disorder costs twice as much in lost productivity as major depressive disorder, a study funded by the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) has found. Each U.S. worker with bipolar disorder averaged 65.5 lost workdays in a year, compared to 27.2 for major depression. Even though major depression is more than six times as prevalent, bipolar disorder costs the U.S. workplace nearly half as much -- a disproportionately high $14.1 billion annually. Researchers traced the higher toll mostly to bipolar disorder's more severe depressive episodes rather than to its agitated manic periods. The study by Drs. Ronald Kessler, Philip Wang, Harvard University, and colleagues, is among two on mood disorders in the workplace published in the September 2006 issue of the American Journal of Psychiatry.
Their study is the first to distinguish the impact of depressive episodes due to bipolar disorder from those due to major depressive disorder on the workplace. It is based on one-year data from 3378 employed respondents to the National Co-morbidity Survey Replication, a nationally representative household survey of 9,282 U.S. adults, conducted in 2001-2003.
The researchers measured the persistence of the disorders by asking respondents how many days during the past year they experienced an episode of mood disorder. They judged the severity based on symptoms during a worst month. Lost work days due to absence or poor functioning on the job, combined with salary data, yielded an estimate of lost productivity due to the disorders.
Poor functioning while at work accounted for more lost days than absenteeism. Although only about 1 percent of workers have bipolar disorder in a year, compared to 6.4 percent with major depression, the researchers projected that bipolar disorder accounts for 96.2 million lost workdays and $14.1 billion in lost salary-equivalent productivity, compared to 225 million workdays and $36.6 billion for major depression annually in the United States.
About three-fourths of bipolar respondents had experienced depressive episodes over the past year, with about 63 percent also having agitated manic or hypomanic episodes. The bipolar-associated depressive episodes were much more persistent - affecting 134-164 days - compared to only 98 days for major depression. The bipolar-associated depressive episodes were also more severe. All measures of lost work performance were consistently higher among workers with bipolar disorder who had major depressive episodes than those who reported only manic or hypomanic episodes. The latter workers' lost performance was on a par with workers who had major depressive disorder.
"Major depressive episodes due to bipolar disorder are sometimes incorrectly treated as major depressive disorder," noted Wang. "Since antidepressants can trigger the onset of mania, workplace programs should first rule out the possibility that a depressive episode may be due to bipolar disorder."
Future effectiveness trials could gauge the return on investment for employers offering coordinated evaluations and treatment for both mood disorders, he said.
Also participating in the study were: Dr. Kathleen Merikangas, NIMH; Dr. Minnie Ames and Robert Jin, Harvard University; Dr. Howard Birnbaum, Paul Greenberg, Analysis Group Inc.; Dr. Robert Hirschfeld, University of Texas; Dr. Hagop Akiskal, University of California San Diego.
In a related NIMH-funded study in the same issue of the American Journal of Psychiatry, Drs. Debra Lerner, David Adler, and colleagues, Tufts University School of Medicine and Tufts-New England Medical Center, found that many aspects of job performance are impaired by depression and that the effects linger even after symptoms have improved.
The researchers tracked the job performance and productivity of 286 employed patients with depression and dysthymia, 93 with rheumatoid arthritis and 193 healthy controls recruited from primary care physician practices for 18 months. While job performance improved as depression symptoms waned, even "clinically improved" depressed patients performed worse than healthy controls on mental, interpersonal, time management, output and physical tasks. The arthritis patients showed greater impairment, compared to healthy controls, only for physical job demands.
Noting that 44 percent of the depressed patients were already taking antidepressants when they began the study and still met clinical criteria for depression - and that job performance continued to suffer despite some clinical improvement - the researchers recommended that the goal of depression treatment should be remission. They also suggest that health professionals pay more attention to recovery of work function and that workplace supports be developed, perhaps through employee assistance programs and worksite occupational health clinics, to help depressed patients better manage job demands.
Research Study Source: Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers