BACKGROUND: Developing safe and effective long-term treatments for bipolardisorder remains a major challenge. Given available treatments, patients withbipolar disorder remain unwell in half of long-term follow-up, mostly indepression. As memantine, an N-methyl-D-aspartate (NMDA)-glutamate receptorantagonist used to treat dementia, has been proposed for testing in bipolardisorder, we carried out a 3 + 3-year, mirror-image, chart-review study of theeffects of adding memantine to stably continued, but insufficiently effective,ongoing mood-stabilizing treatments.METHOD: Outpatients diagnosed with DSM-IV-TR bipolar disorder (I or II), followedintensively at the Lucio Bini Mood Disorder Center, Rome, Italy, had respondedconsistently unsatisfactorily to standard treatments (lithium, anticonvulsants,antipsychotics, antidepressants, and electroconvulsive therapy) for ≥ 3 years(2005-2013). Memantine (20-30 mg/d) was added clinically to otherwise stableregimens for another 3 years. On the basis of chart review, we compared morbiditymeasures and Clinical Global Impressions scale for Bipolar Disorder (CGI-BP)score before versus during memantine treatment.RESULTS: The 30 bipolar I (n = 17) and II (n = 13) subjects showed consistentmorbidity for 3 years before memantine, but improved progressively (r = 0.28, P <.01) over 3 years with memantine (23 ± 4.8 mg/d). Markedly decreased (all Pvalues ≤ .01) were (1) percentage of time ill (total, mania, or depression;averaging -75.0%), (2) CGI-BP severity scores (-67.8%), (3) duration of newepisodes (-58.6%), and (4) episodes/year (-55.7%). Subjects with previous rapidor continuous cycling were particularly improved (t = 2.61, P = .016). Adverseeffects were mild and rare.CONCLUSIONS: Memantine added substantial long-term benefits by preventing orameliorating depressive as well as mania-like morbidity in previouslyconsistently poorly responsive patients with bipolar disorder. Further testing inrandomized, controlled trials is required.
Three-year, naturalistic, mirror-image assessment of adding memantine to the treatment of 30 treatment-resistant patients with bipolar disorder
KOUKOPOULOS, ALEXIA;
2015-01-01
Abstract
BACKGROUND: Developing safe and effective long-term treatments for bipolardisorder remains a major challenge. Given available treatments, patients withbipolar disorder remain unwell in half of long-term follow-up, mostly indepression. As memantine, an N-methyl-D-aspartate (NMDA)-glutamate receptorantagonist used to treat dementia, has been proposed for testing in bipolardisorder, we carried out a 3 + 3-year, mirror-image, chart-review study of theeffects of adding memantine to stably continued, but insufficiently effective,ongoing mood-stabilizing treatments.METHOD: Outpatients diagnosed with DSM-IV-TR bipolar disorder (I or II), followedintensively at the Lucio Bini Mood Disorder Center, Rome, Italy, had respondedconsistently unsatisfactorily to standard treatments (lithium, anticonvulsants,antipsychotics, antidepressants, and electroconvulsive therapy) for ≥ 3 years(2005-2013). Memantine (20-30 mg/d) was added clinically to otherwise stableregimens for another 3 years. On the basis of chart review, we compared morbiditymeasures and Clinical Global Impressions scale for Bipolar Disorder (CGI-BP)score before versus during memantine treatment.RESULTS: The 30 bipolar I (n = 17) and II (n = 13) subjects showed consistentmorbidity for 3 years before memantine, but improved progressively (r = 0.28, P <.01) over 3 years with memantine (23 ± 4.8 mg/d). Markedly decreased (all Pvalues ≤ .01) were (1) percentage of time ill (total, mania, or depression;averaging -75.0%), (2) CGI-BP severity scores (-67.8%), (3) duration of newepisodes (-58.6%), and (4) episodes/year (-55.7%). Subjects with previous rapidor continuous cycling were particularly improved (t = 2.61, P = .016). Adverseeffects were mild and rare.CONCLUSIONS: Memantine added substantial long-term benefits by preventing orameliorating depressive as well as mania-like morbidity in previouslyconsistently poorly responsive patients with bipolar disorder. Further testing inrandomized, controlled trials is required.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
