Treating Bipolar Depression: Part I

One retrospective study of Stanley Foundation patients did find some benefit in patients remaining on their antidepressant, but this applied to only 15 percent of the patients in the study. Now if researchers could only figure out in advance which 15 percent.

What to Make of the STAR*D Findings

This year, the NIMH began releasing the results of a series of real world clinical trials known as STAR*D. A population of 4,000 patients with unipolar depression were first tried on an antidepressant. Those who failed on the antidepressant were tried on a different antidepressant treatment, and those who failed on the second antidepressant treatment were tried yet again on another, and so on to four rounds of treatment.

Of those who stayed in the study, 67 percent remitted. After two failures, the success rate dropped off sharply. These are the “official” results of the trials. The world’s leading authority on bipolar disorder, however, had a different take. In correspondence to me, Frederick Goodwin MD, co-author of “Manic-Depressive Illness” and former head of the NIMH pointed out to me that most of the patients in the study had experienced six or more depressions. In other words, their depressions fell into the “recurrent” rather than “chronic” category.

The cycling nature of these depressions may account for why so many patients in the study kept failing on their antidepressants or dropped out of the study in apparent frustration. These patients may have benefited from treatment as if they had bipolar. Unfortunately, STAR*D did not test for this.

Next: Treating the cycle rather than the symptom …