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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on April 29, 2010, at 20:49:54
Don't quite get this seems that study shows prozac superior to lithium in Bipolar II prevention after depressive episode. Phillipa
From Reuters Health Information
Fluoxetine Edges Lithium in Bipolar Disorder II Depression
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Click here NEW YORK (Reuters Health) Apr 27 - Fluoxetine appears superior to lithium in preventing recurrence of major depressive episodes in patients with bipolar type II, according to new research.Patients taking lithium were at risk of suffering a relapse much sooner than those on fluoxetine (Prozac), according to a study published online April 1st in the American Journal of Psychiatry. Moreover, the researchers found no significant difference in hypomanic symptoms between the two drugs.
During the trial's first 12 weeks, Dr. Jay D. Amsterdam and Dr. Justine Shults, both at the University of Pennsylvania in Philadelphia, used fluoxetine monotherapy, 20 to 80 mg/day, to treat 167 patients with bipolar II and a current major depressive episode. At week 12, 83 patients had recovered, and 81 agreed to participate in the randomization phase. For the next 50 weeks, subjects took either fluoxetine (10 to 40 mg/day), lithium (300 to 1200 mg/day), or placebo.
The mean time to relapse was 250 days in the fluoxetine group, 156 days in the lithium group, and 187 days with placebo.
"The estimated hazard of relapse with lithium was 2.5 times greater than with fluoxetine," the researchers write.
The risk of relapse was not higher with either drug compared to placebo, however. The proportions of patients who relapsed were 32.1% on fluoxetine, 57.7% on lithium, and 51.9% on placebo.
There were no statistically significant or clinically meaningful differences in hypomanic symptoms among groups.
"These findings suggest that long-term fluoxetine monotherapy may provide superior relapse-prevention benefit relative to lithium monotherapy" after recovery from a bipolar II major depressive episode, the investigators conclude.
"Current practice guidelines for treating bipolar disorder do not distinguish between bipolar I and bipolar II disorder," Dr. Amsterdam told Reuters Health by email. "In general, practice guidelines are based upon either expert consensus or, on occasion, evidence-based reviews. However, there are a paucity of controlled clinical trials that have actually tested the efficacy and tolerability of the recommended therapies in a rigorous fashion. Our study has attempted to do so."
"More attention should be focused on the characterization, diagnosis, and treatment approach of bipolar type II disorder," he added. "This disorder may be clinically (and possibly biochemically) distinct from bipolar type I disorder, and may require a different treatment approach. This would be akin to the distinction between type I and type II diabetes, and the differences in recommended treatment approach between those disorders."
Am J Psychiatry 2010
Posted by Purple40 on April 30, 2010, at 9:39:51
In reply to Lithium vs Prozac in Bipolar II Interesting, posted by Phillipa on April 29, 2010, at 20:49:54
I found this to be very surprising and interesting. I'm no expert but had no idea that Prozac could work as a catalyst for bi-polar and better than Lithium at that. I've read that many people are not happy with Lithium or have been taking it a long time and switched to Abilify and didn't like the results. I wonder if taking Prozac and even small dose of Lithium would be an answer for some people. I think we are all gunei pigs (can't spell since on all these meds!)
Posted by desolationrower on April 30, 2010, at 9:58:23
In reply to Re: Lithium vs Prozac in Bipolar II Interesting, posted by Purple40 on April 30, 2010, at 9:39:51
well, prozac worked better *for those it already was working for*
thats not that surprising
would have been more interesting if the Li group was people who recovered on the Li, not prozac
-d/r
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