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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by bipolarspectrum on November 5, 2004, at 12:00:55
Hi,
anyone tried mifepristone (ru-486) for depression?? particularly the depressive phase of bipolar disorder?
thanx for the read
bps
Posted by SLS on November 5, 2004, at 12:40:04
In reply to anyone tried MIFEPRISTONE (RU-486)??, posted by bipolarspectrum on November 5, 2004, at 12:00:55
> Hi,
> anyone tried mifepristone (ru-486) for depression?? particularly the depressive phase of bipolar disorder?
> thanx for the read
> bps
It's next on my list.I have treatment-resistant bipolar depression.
- Scott
Posted by SLS on November 5, 2004, at 12:43:51
In reply to anyone tried MIFEPRISTONE (RU-486)??, posted by bipolarspectrum on November 5, 2004, at 12:00:55
> Hi,
> anyone tried mifepristone (ru-486) for depression?? particularly the depressive phase of bipolar disorder?
> thanx for the read
> bpsBesides Alan Schatzberg, do you know the names of anyone who is using it or involved in clinical investigations? I am particularly interested in anyone doing work at the NIMH. They have an ongoing investigation there for bipolar depression. I believe they are still recruiting volunteers.
- Scott
Posted by jrbecker on November 5, 2004, at 13:02:45
In reply to Re: anyone tried MIFEPRISTONE (RU-486)?? » bipolarspectrum, posted by SLS on November 5, 2004, at 12:43:51
> > Hi,
> > anyone tried mifepristone (ru-486) for depression?? particularly the depressive phase of bipolar disorder?
> > thanx for the read
> > bps
>
> Besides Alan Schatzberg, do you know the names of anyone who is using it or involved in clinical investigations? I am particularly interested in anyone doing work at the NIMH. They have an ongoing investigation there for bipolar depression. I believe they are still recruiting volunteers.
>
>
> - Scott
have you tried calling Corcept about the upcoming Corcept (MIFEPRISTONE) trials? unfortunately, it is not open-label and you have to exhibit psychotic symptoms. feel like pretending to be delusional for a while?http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/10-19-2004/0002288259&EDATE=
Corcept Therapeutics
275 Middlefield Road, Suite A
Menlo Park, California 94025
Telephone: (650) 327-3270; Fax: (650) 327-3218
The only current trial I could find online besides the NIMH ...http://www.clinicaltrials.gov/ct/show/NCT00043654?order=1
was this one at Stanford...
http://www.centerwatch.com/patient/studies/stu39487.html
if anything, hopefully this can give you some information on who are the top researchers involved with this drug.
Posted by SLS on November 5, 2004, at 13:29:26
In reply to Re: anyone tried MIFEPRISTONE (RU-486)?? » SLS, posted by jrbecker on November 5, 2004, at 13:02:45
Hi JB.
Thanks for the information.
I am encouraged that the NIMH is looking at mifepristone specifically for bipolar depression. It can be inferred that they are assessing its potential to reduce the symptoms of depression per se. However, I find it troubling that the studies looking at psychotic depression are only focused on the PSS, and not on depressive symptoms. It is as if they don't believe that it will help with depression globally, but only with its psychotic aspects. I would be dismayed to learn that this is all the drug does.
- Scott
Posted by jrbecker on November 5, 2004, at 13:30:02
In reply to Re: anyone tried MIFEPRISTONE (RU-486)?? » SLS, posted by jrbecker on November 5, 2004, at 13:02:45
Scott-
I should add caution to the potential for Mifepristone as a potent antidepressant for non-psychotic individuals. Most past studies have showed improvement on affective measures, but a more recent study found that, althoug both cognitive as well as psychotic symptoms were ammeliorated, they did not see improvement on a depresssion scale (the Montgomery-Abel [MADRS]).
CORCEPT’S Corlux (mifepristone, RU-486,C-1073)
This drug is approved as an abortifacient, but it may also have value in treating psychotic major depression (PMD). The dose for PMD is seven times the dose needed as an abortifacient. A
speaker said, “Psychotic patients tend to have cognitive defects. Increased cortisol activity is a hallmark of this disorder; psychotics have high cortisol levels…With Corlux, there is normalization of the cortisol rhythm…We did not see an effect on MADRS…It is really in the psychotic symptom domain that you see an effect…Mifepristone appears to reduce psychotic symptoms in PMD.”Trends-in-Medicine newsletter, June 2004.
I have sent the full study to your email account [Biol Psychiatry 2002}.
Of course, this was just one study though. Considering how tied psychosis is to anxiety and overall mood, it wouldn't be surprising to find that mifepristone would be as effective an antidepressant as an antipsychotic. But it remains to be seen whether this would be useful for others outside the psychotic symptomology.
here are some other studies involving mifepristone that tracked antidepressant effects...
Neuropsychopharmacology. 2004 Aug;29(8):1538-45. Related Articles, Links
Improvements in neurocognitive function and mood following adjunctive treatment with mifepristone (RU-486) in bipolar disorder.Young AH, Gallagher P, Watson S, Del-Estal D, Owen BM, Nicol Ferrier I.
Stanley Research Centre, School of Neurology, Neurobiology and Psychiatry, University of Newcastle upon Tyne, UK. [email protected]
High cortisol levels are found in severe mood disorders, particularly bipolar disorder. Hypercortisolaemia may cause or exacerbate both neurocognitive impairment and depressive symptoms. We hypothesized that antiglucocorticoid treatments, particularly corticosteroid receptor antagonists, would improve neurocognitive functioning and attenuate depressive symptoms in this disorder. To test this hypothesis, 20 bipolar patients were treated with 600 mg/day of the corticosteroid receptor antagonist mifepristone (RU-486) or placebo for 1 week in a double-blind crossover design. Over the total 6 weeks of the study, neurocognitive and neuroendocrine function were evaluated at baseline, days 21 and 42. Mood symptoms were evaluated weekly. Nineteen subjects completed the protocol; there were no drop-outs due to adverse events. Following treatment with mifepristone, selective improvement in neurocognitive functioning was observed. Spatial working memory performance was significantly improved compared to placebo (19.8% improvement over placebo). Measures of verbal fluency and spatial recognition memory were also improved after mifepristone. Beneficial effects on mood were found; Hamilton Depression Rating Scale scores were significantly reduced compared to baseline (mean reduction of 5.1 points) as were Montgomery-Asberg Depression Rating Scale scores (mean reduction of 6.05 points). No significant change occurred after placebo. These data require replication but provide preliminary evidence that glucocorticoid receptor antagonists may have useful cognitive-enhancing and possibly antidepressant properties in bipolar disorder.
J Clin Psychopharmacol. 2001 Oct;21(5):516-21. Related Articles, Links
Rapid reversal of psychotic depression using mifepristone.Belanoff JK, Flores BH, Kalezhan M, Sund B, Schatzberg AF.
Department of Psychiatry, Stanford University Medical Center, California 94305, USA.
The rationale for treating psychotic major depression with glucocorticoid receptor (GR) antagonists is reviewed. Five patients with psychotic major depression were given 600 mg of mifepristone in a 4-day, double-blind, placebo-controlled crossover study. All the patients completed the protocol and adverse effects were not observed or reported. All of the five patients showed substantial improvements in their Hamilton Rating Scale for Depression scores while they were receiving mifepristone, and four of the five patients showed substantial improvement in their Brief Psychiatric Rating Scale scores. Little, if any, improvement was seen with placebo. These preliminary results suggest that short-term use of GR antagonists may be effective in the treatment of psychotic major depression and that additional study, perhaps using higher doses or more treatment days, seems warranted.
Posted by SLS on November 5, 2004, at 14:07:51
In reply to Re: anyone tried MIFEPRISTONE (RU-486)??, posted by jrbecker on November 5, 2004, at 13:30:02
This sounds like, at best, a modest antidepressant effect, or the patients did not have such a severe depression to start with.
- Scott---------------------------------------------
Improvements in neurocognitive function and mood following adjunctive treatment with mifepristone (RU-486) in bipolar disorder
Young AH, Gallagher P, Watson S, Del-Estal D, Owen BM, Nicol Ferrier I.
Stanley Research Centre, School of Neurology, Neurobiology and Psychiatry, University of Newcastle upon Tyne, UK. [email protected]
"Beneficial effects on mood were found; Hamilton Depression Rating Scale scores were significantly reduced compared to baseline (mean reduction of 5.1 points) as were Montgomery-Asberg Depression Rating Scale scores (mean reduction of 6.05 points)."
---------------------------------------------
Posted by aazospiro on November 6, 2004, at 18:40:44
In reply to Re: anyone tried MIFEPRISTONE (RU-486)?? » jrbecker, posted by SLS on November 5, 2004, at 14:07:51
Interesting that this is mentioned.
All posters and researcher would be interested to know that at least one person has had a bad run-in with prescription NSAIDs diclofenac potassium and meloxicam and sulindac which all seemed to exacerbate previously stabilized moodswings and ADD symptoms. These agents seemed to antagonize the effect of Concerta XL.
Posted by denise1904 on November 16, 2004, at 12:26:00
In reply to Re: anyone tried MIFEPRISTONE (RU-486)??, posted by aazospiro on November 6, 2004, at 18:40:44
Hi,
I spoke to a person in England who was involved in running a trial in the UK at Newcastle University I think it was and he told me that the drug seemed to be more effective for the psychotic symptoms. He told me that whilst it helped the depression whilst the subjects were taking the medication the depression came back when they stopped taking it whereas the psychotic symptoms didn't.
They're now thinking of doing a trial for bipolar if anyone in the UK is interested let me know and I'll get you the details.
Denise
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