Posted by amy_oz on November 14, 2002, at 16:24:04
Hi,
Found these in medscape. Thought a few of you might be interested.hugs,
Amy
Psychiatry, October 2002 Journal ScanFrom
Journal of Clinical Psychopharmacology
October 2002 (Volume 22, Number 5)Treatment of Bipolar I Rapid Cycling Patients During Dysphoric Mania With Olanzapine
Gonzalez-Pinto A, Tohen M, Lalaguna B, et al.
Journal of Clinical Psychopharmacology. 2002;22(5):450-454Mixed states of bipolar illness are now seen as a fairly commonplace mood state in the disorder. Clinical experience has shown that standard pharmacotherapy may be less effective for the mixed state than for other mood states. The authors attempted to study the effectiveness of olanzapine as an adjunctive agent in the treatment of mixed bipolar states. They evaluated 13 patients in this study who had been treated with mood stabilizers for at least a year and diagnosed with a mixed state; all met the criteria for rapid cycling. Olanzapine was added in an open fashion (mean dosage, 16.15 mg/day) and there was a reduction in both manic and depressive symptoms in all patients as observed on several rating scales. Ten of the patients met the criteria for a response to the treatment. Most common side effects included somnolence and weight gain. The authors concluded that a combination of a mood stabilizer with olanzapine might be an effective treatment option for patients with a mixed bipolar state.
Medscape Medical News
Olanzapine Better Than Lithium for Bipolar I Maintenance
Laurie Barclay, MD
Sept. 20, 2002 — The first randomized double-blind comparison of olanzapine (Zyprexa) and lithium found the former to be superior for maintenance treatment of bipolar I disorder, according to a presentation at the Third European Stanley Foundation Conference on Bipolar Disorder held in Freiberg, Germany."While both drugs performed well, Zyprexa was found to be superior to lithium," Frederick Goodwin, MD, from George Washington University Medical Center in Washington, D.C., says in a news release. "This is especially impressive from a clinical standpoint given that lithium has been the gold standard for decades for the prevention of mania."
This study followed 543 patients with bipolar I disorder, manic or mixed episode, with a history of at least two manic or mixed episodes within six years. After receiving open-label olanzapine and lithium combination therapy for six to 12 weeks, 431 (79%) of the 543 patients met remission criteria, defined as a score less than 12 on the Young Mania Rating Scale and a score less than eight on the Hamilton Depression Rating Scale. These patients were randomized to 52 weeks of double-blind monotherapy treatment with olanzapine, 5-20 mg/day or lithium, 0.6-1.2 mEq/L blood level in a dose range of 300-1800 mg/day.
Rates of relapse into mania were significantly less with olanzapine than with lithium (14.3% vs. 28.0%, P<.001), although rates of relapse into a depressive episode were similar between groups (16.1% vs. 15.4%, P=.895). Estimated time for 25% of patients to relapse was 212 days for lithium and 380 days for olanzapine (P<.001).
"This advance is very encouraging for the long-term treatment of the disease, meanwhile, we must continue our efforts to improve outcomes for bipolar depression," Goodwin says.
Hospitalizations occurred in 14.3% of patients treated with olanzapine and in 22.9% of patients treated with lithium (P=.026), and 46.5% of patients in the olanzapine group and 32.7% of patients in the lithium group completed the trial (P=.004). The most common adverse event for olanzapine was depression, while the most common adverse events with lithium were insomnia and mania.
Other common events reported with olanzapine were insomnia, mania, drowsiness and nausea. Weight gain was significantly greater in the olanzapine group than in the lithium group (1.79 kg vs. -1.38 kg, P<.001).
"What we have are two solid treatment options," says Mauricio Tohen, MD, DrPH, from Lilly Research Laboratories. "This study provides further evidence that Zyprexa as a foundational treatment can help patients maintain dependable control in all phases of bipolar disorder, ultimately helping them to move their lives forward."
Third European Stanley Foundation Conference on Bipolar Disorder. September 12-14, 2002.
Reviewed by Gary D. Vogin, MD
poster:amy_oz
thread:127658
URL: http://www.dr-bob.org/babble/20021108/msgs/127658.html