Oxidative stress parameters in unmedicated and treated bipolar subjects during initial manic episode: A possible role for lithium antioxidant effects

Studies have proposed the involvement of oxidative stress and neuronal energy dysfunctions in the pathophysiology of bipolar disorder (BD). This study evaluates plasma levels of the oxidative/energy metabolism markers, thiobarbituric acid reactive substances (TBARS), superoxide dismutase (SOD), catalase (CAT), and neuron-specific enolase (NSE) during initial episodes of mania compared to controls in 75 subjects. Two groups of manic subjects (unmedicated n=30, and lithium-treated n=15) were age/gender matched with healthy controls (n=30). TBARS and antioxidant enzymes activity (SOD and CAT) were increased in unmedicated manic patients compared to controls. Conversely, plasma NSE levels were lower during mania than in the controls. In contrast, acute treatment with lithium showed a significant reduction in both SOD/CAT ratio and TBARS levels. These results suggest that initial manic episodes are associated with both increased oxidative stress parameters and activated antioxidant defenses, which may be related to dysfunctions on energy metabolism and neuroplasticity pathways. Antioxidant effects using lithium in mania were shown, and further studies are necessary to evaluate the potential role of these effects in the pathophysiology and therapeutics of BD.

Polypharmacy and suicide attempts in bipolar disorder

OBJECTIVE

The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder.

METHOD

One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use.

RESULTS

Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs.

CONCLUSIONS

Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.

Decreased plasma brain derived neurotrophic factor levels in unmedicated bipolar patients during manic episode

BACKGROUND

Bipolar disorder (BD) has been increasingly associated with abnormalities in neuroplasticity and cellular resilience. Brain Derived Neurotrophic Factor (BDNF) gene has been considered an important candidate marker for the development of bipolar disorder and this neurotrophin seems involved in intracellular pathways modulated by mood stabilizers. Also, previous studies demonstrated a role for BDNF in the pathophysiology and clinical presentation of mood disorders.

METHODS

We investigated whether BDNF levels are altered during mania. Sixty subjects (14 M and 46 F) were selected and included in the study. Thirty patients meeting SCID-I criteria for manic episode were age and gender matched with thirty healthy controls. Young Mania Rating Scale (YMRS) evaluated the severity of manic episode and its possible association with the neurotrophin levels.

RESULTS

Mean BDNF levels were significantly decreased in drug free/naive (224.8 +/- 76.5 pg/ml) compared to healthy controls (318.5 +/- 114.2), p < .001]. Severity of the manic episode presented a significant negatively correlation to plasma BDNF levels (r= .78; p < .001; Pearson test).

CONCLUSIONS

Overall, these results suggest that the decreased plasma BDNF levels may be directly associated with the pathophysiology and severity of manic symptoms in BD. Further studies are necessary to clarify the role of BDNF as a putative biological marker in BD.

Polypharmacy and suicide attempts in bipolar disorder

OBJECTIVE: The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder. METHOD: One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use. RESULTS: Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs. CONCLUSIONS: Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.

An open trial of reboxetine in obese patients with binge eating disorder

BACKGROUND

The objective of this study was to evaluate the effectiveness and safety of reboxetine, a selective noradrenaline reuptake inhibitor, in the treatment of obese patients with binge eating disorder (BED).

METHOD

Nine outpatients with BED and obesity received reboxetine 8 mg/day for 12 weeks. The number of days with binge eating episodes per week was considered the primary outcome measure. Body weight, body mass index (BMI), Binge Eating Scale (BES), Clinical Global Impression Severity (CGI-S) and the World Health Organization Quality of Life Assessment Scale (WHOQOL-BREF) scores were used as secondary outcome measures. Paired t-test with the last observation carried forward was used to analyze changes from baseline to endpoint.

RESULTS

Five patients completed the study and showed a complete remission of BED. The mean binge days per week was significantly reduced from 4.6+/-1.8 to 0.2+/-0.6, at the end of the study (p=0.0002). Mean BES scores were decreased from 32.3+/-6.3 to 9.3+/-6.8 (p=0.0003). There was also a statistically significant decrease in BMI (from 36.5+/-4.48 to 35.06+/-4.49; p=0.01), and in CGI-S (from 5.1+/-0.9 to 1.4+/-1.01; p=0.0002). Quality of life, assessed using the WHOQOL-BREF was significantly improved on overall quality of life and general health (p=0.02) and on psychological (p=0.03) domain. No serious adverse events were observed.

CONCLUSION

Reboxetine may be an effective and well-tolerated agent in the treatment of BED in obese patients.