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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Phillipa on June 25, 2013, at 20:17:18
Medscape Medical News from the:
10th International Conference on Bipolar Disorders (ICBD)This coverage is not sanctioned by, nor a part of, the International Conference on Bipolar Disorders.
Medscape Medical News > Conference News
New Recs for Antidepressant Use in Bipolar Patients Released
Fran Lowry
Jun 24, 2013
MIAMI The International Society for Bipolar Disorders (ISBD) Task Force has released its long-anticipated recommendations on antidepressant use in bipolar disorders.The new recommendations, which stem from an international collaboration of 70 bipolar disorder experts from around the world, were released here at the 10th International Conference on Bipolar Disorders (ICBD).
"The use of antidepressants in bipolar disorder is very controversial, and we were able to gather the best experts worldwide to do this report," Eduard Vieta, MD, PhD, professor of psychiatry at the University of Barcelona, in Spain, told Medscape Medical News.
The recommendations are the result of a review of 173 studies to assess the quality of the evidence for antidepressant use in this patient population, as well as numerous drafts and revisions.
"The take-home message is that antidepressants have a questionable benefit-risk and should only be used in certain cases in bipolar disorder," Dr. Vieta, who presented the recommendations on behalf of the ISBD Task Force, said in an interview.
"First, they shouldn't be used in mania or in mixed episodes, they should only be used in bipolar depression in patients with a history of a good response in the past to antidepressants and no history of rapid cycling or switches into mania right away," he said.
Dr. Eduard Vieta
Further, antidepressants should not be used in patients with bipolar disease with mixed features during a depressive episode or some manic symptoms during depression, Dr. Vieta said. "This condition is also now recognized in the new DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition] as a subtype of bipolar depression," he said.
The recommendations are currently in press in the American Journal of Psychiatry.
Controversy Remains
"I think it is a very important contribution that we achieved from this task force, and we are very happy with the outcome," Willem Nolen, MD, PhD, professor of psychiatry at University Medical Center Groningen, in the Netherlands, who moderated the oral session, commented to Medscape Medical News.
Dr. Willem Nolen
"It's still clear that there is a lot of controversy, but at least now we have an impression that the recommendations from this report are supported by more than 80% of the authors. This gives all of us who treat bipolar disorder and wonder where antidepressants fit in an important guide that we can rely upon."
Recommendation Highlights
The recommendations for acute treatment of a depressive episode in bipolar disorder include the following:
Adjunctive antidepressants may be used for an acute bipolar I or II depressive episode when there is a history of previous positive response to antidepressants.
Adjunctive antidepressants should be avoided for an acute bipolar I or II depressive episode with 2 or more concomitant core manic symptoms, in the presence of psychomotor agitation or rapid cycling.
For maintenance treatment, the following is recommended:
Maintenance treatment with adjunctive antidepressants may be considered if a patient relapses into a depressive episode after stopping antidepressant therapy.
Information from Industry
Antidepressant monotherapy should be avoided in bipolar I disorder.
Antidepressant monotherapy should be avoided in bipolar I and II depression with 2 or more concomitant core manic symptoms.
The recommendations for antidepressant use in mixed states include the following:
Antidepressants should be avoided during manic and depressive episodes with mixed features.
Antidepressants should be avoided in bipolar patients with predominantly mixed states.
Previously prescribed antidepressants should be discontinued in patients experiencing current mixed states.
The ISBD Task Force also recommended that adjunctive treatment with serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants be considered only after other antidepressants have been tried. If they are used, they should be closely monitored, owing to increased risk for switch or mood destabilization.Dr. Vieta and Dr. Nolen report no relevant financial relationships.
10th International Conference on Bipolar Disorders (ICBD). Abstract 13. Presented June 14, 2013.
Posted by jono_in_adelaide on June 26, 2013, at 0:37:34
In reply to New Rec For Ad's In Bipolar Disorder, posted by Phillipa on June 25, 2013, at 20:17:18
" in patients with a history of a good response in the past to antidepressants"
Going by that, noone shoule ever be treated with an antidepressant for the first time, so noone will ever be treated with an antidepressant
Posted by SLS on June 26, 2013, at 1:33:27
In reply to Re: New Rec For Ad's In Bipolar Disorder, posted by jono_in_adelaide on June 26, 2013, at 0:37:34
> " in patients with a history of a good response in the past to antidepressants"
>
> Going by that, noone shoule ever be treated with an antidepressant for the first time, so noone will ever be treated with an antidepressantI know. This article really is quite silly. It tries very hard to sound important, but fails to say anything new or profoundly insightful. The authors straddle issues and cover their respective butts. So much for this ISBD Task Force and its "long-anticipated recommendations". Worthless.
- Scott
Posted by markwell on June 26, 2013, at 6:42:34
In reply to Re: New Rec For Ad's In Bipolar Disorder, posted by SLS on June 26, 2013, at 1:33:27
I totally agree Scott.
Posted by bleauberry on June 26, 2013, at 14:57:19
In reply to New Rec For Ad's In Bipolar Disorder, posted by Phillipa on June 25, 2013, at 20:17:18
Well, here is a comment from an LLMD that pretty much sums up my beliefs on these useless studies.
...." In bygone days, physicians used the tools readily available: a tuning fork, a stethoscope, a microscope and something else, much more important - our brains. In this day and age of evidence based medicine, where medicine is considered a science; where limited studies(which are not science) are taken out of context, the results of which unreasonably generalized; where physicians work on corporate/HMO time clocks; where the autonomy of individual physicians has been relinquished to the experts; where doctors are encouraged not to think for themselves; where medicine has become a job, not a calling; where the art of medicine has been tossed out like the proverbial baby in the bath water - much is lost. Discoveries which might otherwise be clear, are lost in the muddied waters of mainstream medicine, blinded by a dysfunctional system and by its own arrogance."
My journeys have shown me in solid convincing fashion that psychiatric symptoms of all kinds have a likely stealth infection causing them. Which makes the science thing even more ridiculous.
The Western world helps a few people with great strides in so-called science, but dramatically hurts everyone else with the same science. In this article for example, the discussion should not have been whether to give ADs in bipolar or not, but rather, how do we attack the underlying disease causing it all?
Posted by Phillipa on June 26, 2013, at 19:09:54
In reply to Re: New Rec For Ad's In Bipolar Disorder, posted by bleauberry on June 26, 2013, at 14:57:19
When you say disease you are meaning one that requires antibiotics or herbs to cure. Not all are this easy to cure. Phillipa
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