Clonazepam augmentation of antidepressants: does it distinguish unipolar from bipolar depression
BACKGROUND: The authors compared the effect of clonazepam supplement treatment on unipolar depression and bipolar depression. METHODS: A total of 38 protracted depression patients with unipolar depression (n = 19) or bipolar depression (n = 19) were treated with 3.0 mg clonazepam for 4 weeks. RESULTS: In the unipolar depression group, 84.2% of the subjects fulfilled the response criteria (at least an 80% reduction in their HDRS score). However, in the bipolar depression group, only 10.5% of them fulfilled these criteria. CONCLUSIONS: The difference in responses between the two groups supposes that the underlying abnormality in unipolar depression is not the same as that in bipolar depression. This trial also supposed that clonazepam can play active role in the treatment of protracted depression in patients with unipolar depression. LIMITATIONS: This finding was made in an open study, and the effect on clonazepam alone was not established.
Use of topiramate in treatment-resistant bipolar spectrum disorders.
To evaluate the effectiveness and safety of topiramate as add-on, long-term therapy for treatment-resistant bipolar-spectrum disorders, 34 DSM-IV bipolar-spectrum patients, including bipolar I (n = 28), bipolar II (n = 3), bipolar not otherwise specified (n = 2), and schizoaffective disorder bipolar type (n = 1), considered to be resistant to treatment with lithium, carbamazepine, and valproate, received increasing doses of topiramate as adjunctive therapy for their manic (n = 17), depressive (n = 11), hypomanic (n = 3), or mixed (n = 3) symptoms. Outcome measures included the Young Mania Rating Scale (YMRS), the Hamilton Rating Scale for Depression (HAM-D), and the Clinical Global Impression (CGI) for Severity. Patients were followed up for 6 months. Twenty-five patients (74%) completed the 6-month follow-up. Nine patients (26%) dropped out early due to lost of follow-up (n = 4), worsening of symptoms (n = 2), side effects (n = 1), hospitalization due to intercurrent illness (n = 1), and noncompliance (n = 1). By intent-to-treat analysis, there was a significant reduction in YMRS, HAM-D, and CGI scores (p < 0.0001 for all measures at the endpoint) after the introduction of topiramate. Most therapeutic effects appeared between weeks 2 and 6. Fifty-nine percent of manic patients and 55% of depressed patients were considered to be responders to the drug, which was well tolerated; only one patient discontinued due to side effects. The most common side effect was paraesthesia (n = 2). Ten patients experienced moderate weight loss during the follow-up period. The mean topiramate dose at endpoint was 202 +/- 65 mg/day. These preliminary results indicate that adjunctive topiramate may be useful in the long-term treatment of bipolar spectrum disorders, even in the most difficult-to-treat patients.