Bipolar Patients Need Highly Targeted Treatments

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.

HONOLULU – Regardless of the type of psychotropic medication used to treat patients with bipolar disorder, outcomes are about the same at 1 year, a retrospective chart review from the University of Toledo suggests.

All 121 patients in the study were treated with a mood stabilizer. Some of them had an added antipsychotic, and a significant number also had an antidepressant, lead author Dr. Ronald A. McGinnis said at the annual meeting of the American Psychiatric Association. Across the board, the findings proved consistent. "We found no medication regimen superior to any other," he said.

Those who did not respond to treatment were "as likely to be on an antidepressant, mood stabilizer, or atypical antipsychotic" as were those who did respond. "We looked at individual medications and combinations of medications. No matter how you sliced the data, there were really no statistical differences in medications," despite "a lot of algorithms to follow and expert advice," said Dr. McGinnis, medical director of the University of Toledo (Ohio) Medical Center.

Despite these findings, Dr. McGinnis said he thinks that people do need to be on medications to recover. The point is that the type of medication the patient is taking does not seem to matter. "There are probably some other factors that we are not aware of that have to do with response," he said.

In the study, those factors seemed to include psychological stressors, pain, and missed appointments, all of which are more common in nonresponders. Poverty was more common, too, but the finding was not statistically significant.

For coauthor Dr. Daniel J. Rapport of the department of psychiatry at the university, the take-home message is not that medication choice is irrelevant. On the contrary, he thinks the study suggests that clinicians have to work extra hard to find drugs that work in a given patient.

The assertion is based on the finding that sustained recovery was associated with longer lag times to recovery. It is likely that during that lag time, clinicians were working closely with patients to find the combination of drugs that ultimately worked for them, he said.

Although "it didn’t seem to matter what medications or combinations of medications these people received," specific drugs appear to be more effective and better tolerated in given individuals. "So don’t give up" looking for the right combination. "It’s not the class, it’s the [specific] drug" selected, Dr. Rapport said.

Overall, 43.8% [53] patients achieved at least 12 consecutive months of either euthymia, a much-improved mood, or improvement followed by relapse; 56.1% patients [68] did not respond to treatment, which also included psychotherapy.

"It’s the minority of people who get a clinically meaningful recovery," Dr. McGinnis noted.

In all, 84 patients were men, and most were white. Their average age was 43 years, and average age at diagnosis 25. They were treated for at least a year.

The 121 patients were narrowed down from an original list of 271 who were billed for bipolar disorder over 18 months. The researchers found that 150 of those patients did not actually meet DSM-IV criteria for the disorder.

"We want to go back and see why all these people were billed with bipolar disorder when they really didn’t meet DSM-IV criteria for it," Dr. Rapport said.

In general, when it comes to treating bipolar disorder, he said, "the first thing that you have to do is to stop the cycling, so you use anticycling agents first, like lamotrigine, lithium, Tegretol, or Depakote." Residual symptoms are tackled with "a touch of antidepressants."

Dr. McGinnis said he has no relevant disclosures. Dr. Rapport said he previously spoke on behalf of Lamictal for its maker, GlaxoSmithKline, and worked with other companies. The study received no outside funding.