The most numerous difficult to tre...

The most numerous difficult to treat and disabling aspect of bipolar disorder is the depression phase. Patients with bipolar disorder devote more time in the depressive phase than they do in the manic phase, and it takes longer to cure from the depressive phase. In addition, patients in the depressive phase have higher rates of morbidity and mortality than those in the manic phase. The now passing treatment for bipolar disorder is temper stabilizers such as lithium and anticonvulsants. Another option is olanzapine, which has been effective in treating mania and was erect to improve depressive symptoms in patients with schizophrenia. Tohen and colleagues evaluated the efficacy and safety of olanzapine alone or in combination with fluoxetine in the treatment of bipolar I depression.

The trial was a randomized, double-blind, parallel meditation of patients who met the criteria for bipolar I disorder, disgraceed in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed The selected participants were randomized to receive olanzapine, in a dosage of 5 to 20 mg by means of day, placebo, or an olanzapine-fluoxetine combination of 6 and 25 6 and 50 or 12 and 50 mg by day in a flexible dosing schedule. Participants were assessed at baseline and at weeks 1 2 3 4 6 and 8 of the inquiry The assessment included multiple depression and anxiety scales, using the Montgomery-Asberg Depression Rating Scale (MADRS) as the main consequence measure. The primary outcome evaluated the rates and times to remission, with answer defined as an improvement of 50 percent or greater of the MADRS total score from baseline and completion of at least four weeks of the reflection Remission was defined as a MADRS score of 12 or les at an finis point and completion of at least four weeks of the investigation Adverse events also were recorded at each visit.

There were 833 patients who participated in the inquiry The olanzapine and olanzapine-fluoxetine assign places tos showed significant improvement in all depressive symptoms compared with the placebo form into groups At weeks 4 and 8 of the studious mood the olanzapine-fluoxetine group showed more improvement in depressive symptoms compared with the olanzapinealone assemblage and more patients in the former assign places to met the remission criteria.

Across the three clusters there were no differences in the incidence of treatment-emergent mania. With regard to adverse general intents somnolence, weight gain, increased appetite, headache, dried mouth, and gastrointestinal symptoms were reported. The adverse marked occurrences in the olanzapine-fluoxetine group were similar to those of the olanzapine-alone dispose except for more reports of nausea and diarrhea in the combination group

The authors decide that olanzapine alone is more effective in treating the depressive phase of bipolar disorder than placebo. Adding fluoxetine to olanzapine therapy provides these patients with an calm greater benefit than olanzapine alone. These improvements occurr without increasing the risk of developing manic symptoms during the treatment phase of the research The authors add that these arises need to be followed with a long-term study

Tohen M et al. Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry November 2003;60:1079-88

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