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Bourla A, Ferreri F, Baudry T, Panizzi V, Adrien V, Mouchabac S. Rapid cycling bipolar disorder: Literature review on pharmacological treatment illustrated by a case report on ketamine. Brain Behav 2022; 12:e2483. [PMID: 35041295 PMCID: PMC8865164 DOI: 10.1002/brb3.2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Rapid cycling bipolar disorder (RCBD) is defined as four or more affective episodes (depression, mania or hypomania) within 1 year. RCBD has a high point of prevalence (from 10% to 20% among clinical bipolar samples) and is associated with greater severity, longer illness duration, worse global functioning and higher suicidal risk, but there is no consensus on treatment option. The use of several pharmacological agents has been reported (levothyroxine, antipsychotics, antidepressants and mood stabilizers). OBJECTIVE The main objective of this review was to propose a critical review of the literature and to rank the pharmacological agent using a level of evidence (LEO) adapted from the Center for Evidence-Based Medicine, and to illustrate it with a case report on off-label intravenous ketamine. METHOD We conducted a review using the MeSH terms and keywords (bipolar [Title/Abstract]) AND (rapid [Title/Abstract]) AND (cycling [Title/Abstract]) AND (treatment [Title/Abstract]). Alexis Bourla and Stéphane Mouchabac screened 638 documents identified through literature search in Medline (PubMed) or by bibliographic references and 164 abstracts were then analyzed. Nonpharmacological treatments were excluded. RESULT Seventy articles were included in the review and divided into six categories: mood stabilizers, antipsychotics, hormonal treatments, ketamine and other pharmacological treatments. DISCUSSION Our review highlights the heterogeneity of the pharmacological treatment of RCBD and no clear consensus can emerge.
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Affiliation(s)
- Alexis Bourla
- Sorbonne Université, AP-HP, Department of Psychiatry, Hôpital Saint-Antoine, Paris, France.,Sorbonne Université, ICRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain Institute (ICM), INSERM, CNRS, Paris, France.,INICEA, Jeanne d'Arc Hospital, Korian, Saint-Mandé, France
| | - Florian Ferreri
- Sorbonne Université, AP-HP, Department of Psychiatry, Hôpital Saint-Antoine, Paris, France.,Sorbonne Université, ICRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Thomas Baudry
- Sorbonne Université, AP-HP, Department of Psychiatry, Hôpital Saint-Antoine, Paris, France
| | - Vincent Panizzi
- Sorbonne Université, AP-HP, Department of Psychiatry, Hôpital Saint-Antoine, Paris, France
| | - Vladimir Adrien
- Sorbonne Université, AP-HP, Department of Psychiatry, Hôpital Saint-Antoine, Paris, France.,Sorbonne Université, ICRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Stéphane Mouchabac
- Sorbonne Université, AP-HP, Department of Psychiatry, Hôpital Saint-Antoine, Paris, France.,Sorbonne Université, ICRIN Psychiatry (Infrastructure of Clinical Research In Neurosciences - Psychiatry), Brain Institute (ICM), INSERM, CNRS, Paris, France
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Morishita S. Clonazepam as a therapeutic adjunct to improve the management of depression: a brief review. Hum Psychopharmacol 2009; 24:191-8. [PMID: 19330803 DOI: 10.1002/hup.1015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Clonazepam, first used for seizure disorders, is now increasingly used to treat affective disorders. We summarize the use of clonazepam to improve the management of depression. Clonazepam is useful for treatment-resistant and/or protracted depression, as well as for acceleration of response to conventional antidepressants. Clonazepam is at this time recommended for use in combination with SSRIs (fluoxetine, fluvoxamine, sertraline) as an antidepressant, and should be used at a dosage of 2.5-6.0 mg/day. If clonazepam is effective, a response should be observed within 2-4 weeks. It is significantly more effective for unipolar than for bipolar depression. Low-dose, long-term treatment with clonazepam exhibits a prophylactic effect against recurrence of depression. Although the mechanism of action of clonazepam has not yet been established, some investigators have been suggested that it involves enhancement of anti-anxiety effects, anticonvulsant effects on subclinical epilepsy, increase in 5-HT/monoamine synthesis or decrease in 5-HT receptor sensitivity mediated through the GABA system, and regulate in GABA activity.
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Affiliation(s)
- Shigeru Morishita
- Depression Prevention Medical Center, Kyoto Jujo Rehabilitation Hospital, Minami-ku, Kyoto, Japan.
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Morishita S, Arita S. Possible predictors of response to clonazepam augmentation therapy in patients with protracted depression. Hum Psychopharmacol 2007; 22:27-31. [PMID: 17191267 DOI: 10.1002/hup.818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Clonazepam has been shown to be an effective supplementary treatment for depression. Thus, it would be useful to determine which patient characteristics are associated with response to clonazepam. AIMS The purpose of this study was to examine the possible predictors of response to clonazepam in the treatment of depression. METHOD A retrospective cohort analysis was carried out in 120 patients with protracted depression who were being treated with clonazepam. RESULTS A variety of clinical factors, including age, gender, type of depression, frequency of episodes, family history; and daily dose of clonazepam, were analyzed as possible predictors of response to clonazepam. A Weibull regression analysis showed that the factors that best predicted improvement with clonazepam augmentation were negative family history of psychiatric illness (e(coef) = 0.378), daily clonazepam dose of 2.5-4.0 mg (e(coef) = 0.160), and unipolar depression (e(coef) = 0.147). CONCLUSIONS These factors should be considered when clonazepam augmentation therapy is selected for protracted depression.
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Affiliation(s)
- Shigeru Morishita
- Depression Prevention Medical Center, Kyoto Jujo Rehabilitation Hospital, Kyoto, Japan.
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