Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-29T03:01:20.733Z Has data issue: false hasContentIssue false

The Role of Complex Combination Therapy in the Treatment of Refractory Bipolar Illness

Published online by Cambridge University Press:  03 July 2018

Robert M. Post
Affiliation:
Biological Psychiatry Branch at the National Institute of Mental health in Bethesda, Md.
Mark A. Frye
Affiliation:
Biological Psychiatry Branch at the National Institute of Mental health in Bethesda, Md.
Gabriele S. Leverich
Affiliation:
Biological Psychiatry Branch at the National Institute of Mental health in Bethesda, Md.
Kirk D. Denicoff
Affiliation:
Biological Psychiatry Branch at the National Institute of Mental health in Bethesda, Md.

Abstract

In this article, we present rationales for using complex combination therapy in treatment-refractory bipolar patients and discuss the agents available for use in this therapeutic approach. We review a case example of successful remission that was achievable only with complex combination therapy, and examine its theoretical implications. Practical approaches to devising the optimal complex combination treatment for individual patients are explained, and we look to the development of new methodologies and a more systematic database for decision making in the future.

Type
Feature Article
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Kraepelin, K. Manic-Depressive Insanity and Paranoia. Barclay, RM, trans: Robertson, GM, ed, Edinburgh, Scotland: ES Livingstone; 1921.Google Scholar
2. Post, RM. Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. Am J Psychiatry. 1992;149:9991010.Google Scholar
3. Post, RM, Weiss, SRB. A speculative model of affective illness cyclicity based on patterns of drug tolerance observed in amygdala-kindled seizures. Mol Neurobiol. 1996;13:3360.CrossRefGoogle ScholarPubMed
4. Marangell, LB, George, MS, Callahan, AM, et al. Effects of intrathecal protirelin (thyrotropin-releasing hormone) in refractory depressed patients. Arch Gen Psychiatry. 1997;54:214222.CrossRefGoogle ScholarPubMed
5. Callahan, AM, Frye, MA, Marangell, LB, et al. Comparative antidepressant effects of intravenous and intrathecal thyrotropin-releasing hormone: confounding effects of tolerance and implication for therapeutics. Biol Psychiatry. 1997;41:264272.CrossRefGoogle ScholarPubMed
6. Prange, AJ Jr, Lara, PP, Wilson, IC, Alltop, LB, Breese, GR. Effects of thyrotropin-releasing hormone in depression. Lancet. 1972;11:9991002.Google Scholar
7. Post, RM, Weiss, SRB. Endogenous biochemical abnormalities in affective illness: therapeutic vs pathogenic. Biol Psychiatry. 1992;32:469484.CrossRefGoogle Scholar
8. Post, RM, Leverich, GS, Pazzaglia, PJ, et al. Lithium tolerance and discontinuation as pathways to refractoriness. In: Birch, NJ, Padgham, C, Hughes, MS, eds. Lithium in Medicine and Biology. Lancashire, UK: Marius Press; 1993;7184.Google Scholar
9. Post, RM, Leverich, GS, Rosoff, AS, Altshuler, LL. Carbamazepine prophylaxis in refractory affective disorders: a focus on long-term follow-up. J Clin Psychopharmacol. l990;10:318327.Google Scholar
10. Weiss, SR, Clark, M, Rosen, JB, Smith, MA, Post, RM. Contingent tolerance to the anticonvulsant effects of carbamazepine: relationship to loss of endogenous adaptive mechanisms. Brain Res Rev. 1995;20:305325.Google Scholar
11. O'Gonnell, RA, Mayo, JA, Flatow, L, Cuthbertson, B, O'Brien, BE. Outcome of bipolar disorder on Long-term treatment with lithium. Br J Psychiatry. 1991;159:123129.Google Scholar
12. Sarantidis, D, Waters, B. Predictors of lithium prophylaxis effectiveness. Prog Neuropsychopharmacol. 1981;5:507510.CrossRefGoogle ScholarPubMed
13. Denicoff, KD, Smith-Jackson, EE, Disney, ER, Ali, SO, Leverich, CS, Post, RM. Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. J Clin Psychiatry. 1997;58:470478.Google Scholar
14. Post, RM, Ketter, TA, Pazzaglia, PJ, et al. Rational polypharmacy in the bipolar affective disorders. Epilepsy Res. 1996;(suppl 11):153180.Google Scholar
15. Gelenberg, AJ, Kane, JM, Keller, MB, et al. Comparison of standard and low serum levels of lithium for maintenance treatment of bipolar disorder. N Engl J Med. 1989;321:14891493.CrossRefGoogle ScholarPubMed
16. Koukopoulos, A, Reginaldi, D, Minnai, G, Serra, G, Pani, L, Johnson, FN. The long term prophylaxis of affective disorders. Adv Biochem Psychopharmacol. 1995;49:127147.Google Scholar
17. Markar, HR, Mander, AJ. Efficacy of lithium prophylaxis in clinical practice. Br J Psychiatry. 1989;15:496500.CrossRefGoogle Scholar
18. Vestergaard, P. Treatment and prevention of mania: a Scandinavian perspective. Neuropsychopharmacol. 1992;7:249260.Google Scholar
19. Gitlin, MJ, Swendsen, J, Heller, TL, Hammen, C. Relapse and impairment in bipolar disorder. Am J Psychiatry. 1995;152:16351640.Google Scholar
20. Kravitz, HM, Fawcett, J. Carbamazepine in the treatment of affective disorders. Med Sci Res. l987;15:l8.Google Scholar
21. Schaff, MR, Fawcett, J, Zajecka, JM. Divalproex sodium in the treatment of refractory affective disorders. J Clin Psychiatry. 1993;54:380384.Google Scholar
22. Post, RM, Ketter, TA, Denicoff, K. et al. The place of anticonvulsant therapy in bipolar illness. Psychopharmacology (Berl). 1996;128:115129.CrossRefGoogle ScholarPubMed
23. Post, RM, Denicoff, KD, Frye, MA, Leverich, GS. Re-evaluating carbamazepine prophylaxis in bipolar disorder. Br J Psychiatry. 1997;170:202204.CrossRefGoogle Scholar
24. Frye, MA. The increasing use of polypharmacy for refractory mood disorders: twenty-five years of study. APA New Research Program and Abstracts. 1996;151152. Abstract.Google Scholar
25. Post, RM, Uhde, TW, Roy-Byrne, PP, Joffe, RT. Antidepressant effects of carbamazepine. Am J Psychiatry. 1986;143:2934.Google Scholar
26. Post, RM, Uhde, TW, Roy-Byrne, PP, Joffe, RT. Correlates of antimanic response to carbamazepine. Psychiatry Res. 1987;21:7183.CrossRefGoogle ScholarPubMed
27. Kramlinger, KG, Post, RM. The addition of lithium carbonate to carbamazepine: antidepressant efficacy in treatment-resistant depression. Arch Gen Psychiatry. l989;46:794800.Google Scholar
28. Semyak, MJ, Woods, SW. Chronic neuroleptic use in manic-depressive illness. Psychopharmacol Bull. 1993;29:375381.Google Scholar
29. Hunt, N, Silverstone, T. Tardive dyskinesia in bipolar affective disorder a catchment area study. Int Clin Psychopharmacol. 1991;6:4550.CrossRefGoogle ScholarPubMed
30. Jeste, DV, Wyatt, RJ. Therapeutic strategies against tardive dyskinesia. Arch Gen Psychiatry. 1982;39:803816.Google Scholar
31. Glenthoj, B, Hemmingsen, R, Allerup, P, Bolwig, TG. Intermittent versus continuous neuroleptic treatment in a rat model. Eur J Pharmacol. 1990;190:275286.CrossRefGoogle ScholarPubMed
32. Calabrese, JR, Kimmel, SE, Woyshville, MJ. et al. Clozapine for treatment-refractory mania. Am J Psychiatory l996;153:759764.Google Scholar
33. McElroy, SL, Dessain, EC, Pope, HG Jr, et al. Clozapine in the treatment of psychotic mood disorders, schizoaffective disorder, and schizophrenia. J Clin Psychiatry. 1991;52:411414.Google Scholar
34. Suppes, I, McElroy, SI, Gilbert, J, Dessain, EC, Cole, JO. Clozapine in the treatment of dysphoric mania. Biol Psychiatry. 1992;32:270280.Google Scholar
35. Kerwin, R, Taylor, D. New antipsychotics. A review of their current status and clinical potential. CNS Drugs. l996;6:7182.Google Scholar
36. Keek, PE Jr., Wilson, DR, Strakowski, SM, et al. Clinical predictors of acute risperidone response in schizophrenia, schizoaffective disorder, and psychotic mood disorders. J Clin Psychiatry. 1995;56:466470.Google Scholar
37. Tohen, M, Zarate, CA Jr., Centorrino, F, Hegarty, JI, Froeschl, M, Zarate, SB. Risperidone in the treatment of mania. J Clin Psychiatry. 1996;57:219253.Google ScholarPubMed
38. Gross, C, Kin, X, Gastpar, M. Trimipramine: pharmacological reevaluation and comparison with clozapine. Neuropharmacology. 1991;30:11591166.Google Scholar
39. Eikmeier, G, Berger, M, Lodemann, E, Muszynski, K, Kaumeier, S, Gastpar, M. Trimipramine—an atypical neuroleptic? Int Clin Psychopharmacol 1991;6:117153.Google Scholar
40. Pazzaglia, PJ, Post, RM, Ketter, TA, George, MS, Marangell, LB. Preliminary controlled trial of nimodipine in ultra-rapid cycling affective dysregulation. Psychiatry Res. 1993;49:257272.Google Scholar
41. Pazzaglia, PJ, Post, RM, Ketter, TA, et al.Nimodipine monotherapy and carbamazepine augmentation in patients with refractory recurrent affective illness. J. Clin Psychopharmacol. In press.Google Scholar
42. Dubovsky, SL. Calcium channel antagonists as novel agents for manic-depressive disorder. In: Schatzberg, AF, Nemeroff, CB, eds. Textbook of Psychopharmacology. Washington, DC: American Psychiatric Press; 1995;377388.Google Scholar
43. Pazzaglia, PJ, George, MS, Post, RM, Rubinow, DR, Davis, C. Nimodipine increases CSF somatostatin in affectively ill patients. Neuropsychopharmacol. l995;13:7583.Google Scholar
44. Ban, TA, Morey, L, Aguglia, E, et al. Nimodipine in the treatment of old age dementias. Prog Neuropsychopharmacol Biol Psychiatry. 1990;144:525551.Google Scholar
45. Calabrese, JR, Bowden, CL, McElroy, SL, et al.Lamotrigine in bipolar disorder: preliminary data. Syllabus and Proceedings Summary of the 150th American Psychiatric Association Meeting, May 17-22,1997. Abstract No 33B.Google Scholar
46. Berlant, JL. ADHD and bipolar disorder as predictors of clinical response to lamotrigine. Proceedings of the Second International Conference on Bipolar Disonler, 1997:7. Abstract.Google Scholar
47. Ferrier, IN, Potkins, D, Eccleston, D. Lamotrigine treatment in rapid cycling bipolar disorder (BPD): clinical and biological correlates. Proceedings of the Second International Conference on Bipolar Disonler. 1997;15. Abstract.Google Scholar
48. Hoopes, S, Snow, M. Clinical effectiveness of lamotrigine in affective disorders. Proceedings of the Second International Conference on Bipolar Disonler. 1997:26. Abstract.Google Scholar
49. Frye, MA, Ketter, TA, Kimbrell, TA. et al.Gabapentin and lamotrigine monotherapy in mood disorder. Syllabus and Proceedings Summary of the 150th American Psychiatric Association Meeting, May 17-22, 1997. Abstract No. 33C.Google Scholar
50. Messenheimer, JA. Lamotrigine. Epilepsia. 1995;36(suppl 2):S87S94.CrossRefGoogle ScholarPubMed
51. Sachs, B, Ronnau, AC, von Schmiedeberg, S, Ruzicka, T, Gleiehmann, E, Schuppe, HC. Lamotrigine-induced Stevens-Johnson syndrome: demonstration of specific lymphocyte reactivity in vitro. Dermatology. 1997;195:6064.Google Scholar
52. Sterker, M, Berrouschot, J, Schneider, D. Fatal course of toxic epidermal necrolysis under treatment with lamotrigine. Int J Clin Pharmacol Ther. l995;33:595597.Google Scholar
53. Kocsis, JD, Mattson, RH. GABA levels in the brain: a target for new antiepileptic drugs. The Neuroscientist. 1996;2:326334.Google Scholar
54. Young, LT, Robb, JC, Patelis-Siotis, I, MacDonald, C, Joffe, RT. Acute treatment of bipolar depression with gabapentin. Biol Psychiatry. 1997;42:851853.CrossRefGoogle ScholarPubMed
55. Dimond, KR, Pande, AC, Lamoreaux, L, Pierce, MW. Effect of gabapentin (Neurotonin) on mood and well-being in patienls with epilepsy. Prog Neuropsychopharmacol Biol Psychiatry. 1996;20:407417.CrossRefGoogle Scholar
56. Marcotte, DB, Fogleman, L, Wolfe, N, et al.Gabapentin: an effective therapy for patients with bipolar affective disorder. APA New Research Program and Abstracts. 1997;138. Abstract NR261.Google Scholar
57. Joffe, RT, Singer, W, Levitt, AJ, MacDonald, C. A placebo-controlled comparison of lithium and triiodothyronine augmentation of triryclic antidepressanls in unipolar refractory depression. Arch Gen Psychiatry. 1993;50:387393.Google Scholar
58. Cooke, RG, Joffe, RT, Levitt, AJ. T3 augmentation of antidepressant treatment in T4-replaced thyroid palienls. J Clin Psychiatry. 1992;53:1618.Google Scholar
59. Stancer, HC, Persad, E. Treatment of intractable rapid-cycling manic-depressive disorder with levothyroxine. Arch Gen Psychiatry. 1982;39:311312.Google Scholar
60. Whyhrow, PC. The therapeutic use of triiodothyronine and high dose thyroxine in psychiatric disorder. Acta Med Austriaca. 1994;21:4752.Google Scholar
61. Baumgartner, A, Bauer, M, Hellweg, R. Treatment of intractable non-rapid cycling bipolar affective disorder with high-dose thyroxine: an open clinical trial. Neuropsychopharmacol. 1994;10:183189.Google Scholar
62. Frye, MA, Denicoff, KD, Luckenbaugh, DA, et al.Thyroid potentiation in affective illness. APA New Research Program and Abstracts. 1997. Abstract NR425.Google Scholar
63. Bauer, MS, Whybrow, PC. Rapid cycling bipolar affective disorder. II: treatment of refractory rapid cycling with high-dose levothyroxine: a preliminary study. Arch Gen Psychiatry. 1990;47:435440.Google Scholar
64. Bauer, M, Hellweg, R, Baumgartner, A. Adjunctive treatment with high-dose thyroxine in refractory depression. APA New Research Program and Abstracts. 1996;156. Abstract NR330.Google Scholar
65. Perucca, E. A pharmacological and clinical review on topiramate, a new antiepileptic drug. Pharmacol Res. 1997;35:241256.Google Scholar
66. Shorvon, SD. Safely of topiramate: adverse events and relationships to dosing. Epilepsia, 1996;37(supp] 2):S18S22.Google Scholar
67. Ozaki, N, Chuang, DM. Lithium increases transcription factor binding to AP-1 and cyclic AMP-responsive element in cultured neurons and rad brain. J Neurochem. 1997;69:23362344.Google Scholar
68. Chen, G, Yuan, P, Hawver, DB, Potter, WZ, Manji, HK. Increase in AP-1 transcription factor DNA binding activity by valproic acid. Neuropsychopharmacology. 1997;16:238245.Google Scholar
69. Duman, RS, Heninger, GR, Nestler, EJ. A molecular and cellular theory of depression. Arch Gen Psychiatry. 1997;54:597606.Google Scholar
70. Smith, MA, Makino, S, Allemus, M, et al. Stress and antidepressants differentially regulate neurotrophin 3 mRNA expression in ihe locus coeruleus. Proc Natl Acad Sci USA. 1995;92:87888792.CrossRefGoogle Scholar
71. Siuciak, JA, Lewis, DR, Wiegand, SJ, Lindsay, RM. Antidepressant-like effect of brain-derived neurotrophic factor (BDNF). Pharmacol Biochem Rehar. 1997;56:131137.CrossRefGoogle ScholarPubMed
72. Baastrup, PC, Schou, M. Lithium as a prophylactic agent: its effect against recurrent depressions and manic-depressive psychosis. Arch Gen Psychiatry. 1967;16:162172.Google Scholar
73. Suppes, T, Baldessarini, RJ, Faedda, GL, Tohen, M. Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Arch Gen Psychiatry. 1991;48:10821088.Google Scholar
74. Faedda, GL, Tondo, L, Baldessarini, RJ, Suppes, T, Tohen, M. Outcome after rapid vs gradual discontinuation of lithium treatment in bipolar disorders. Arch Gen Psychiatry: 1993;50:448455.Google Scholar
75. Post, RM, Leverich, GS, Altshuler, L, Mikalauskas, K. Lithium discontinuation-induced refractoriness: preliminary observations. Am J Psychiatry. 1992;149:17271729.Google Scholar
76. Brodie, MJ, Yuen, AW. Lamotrigine substitution study: evidence for synergism with sodium valproate? 105 Study Group. Epilepsy Res. 1997;26:423432.Google Scholar
77. Ketter, TA, Kimbrell, TA, George, MS, et al.Baseline hypermetabolism may predict carbamazepine response, and hypometabolism nimodipine response in mood disorders. Abstracts of the XXth CINP Congress. 1996:10.Google Scholar
78. Frye, MA, Pazzaglia, PJ, Luckenbaugh, D, et al.Baseline CSF somatostatin predictive of nimodipine treatment response. Biol Psychiatry. 1997;41:335. Abstract.Google Scholar
79. George, MS, Wassermann, EM, Williams, WA, et al. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. NeuroReport. 1995;6:18531856.Google Scholar
80. George, MS, Wassermann, EM, Kimbrell, TA, et al. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. Am J Psychiatry. 1997;154:17521756.Google Scholar
81. Pascual-Leone, A, Rubio, B, Pallardo, F, Catala, MD. Rapidrale transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression, Lancet 1996;348:233237.Google Scholar