Venlafaxine monotherapy in bipolar type II depressed patients unresponsive to prior lithium monotherapy

Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 08/2009; 121(3):201-8. DOI: 10.1111/j.1600-0447.2009.01462.x
Source: PubMed


We examine the safety and efficacy of venlafaxine monotherapy in bipolar type II (BP II) patients with major depressive episode (MDE) who were unresponsive to prior lithium monotherapy. We hypothesized that venlafaxine would be superior to lithium with a low hypomanic conversion rate.
Seventeen patients who were unresponsive to prior lithium monotherapy were crossed to venlafaxine monotherapy for 12 weeks. The primary outcome was within-subject change in total Hamilton Depression Rating (HAM-D) score over time. Secondary outcomes included the change in Young Mania Rating (YMRS) and clinical global impressions severity (CGI/S) and change (CGI/C) scores.
Venlafaxine produced significantly greater reductions in HAM-D (P < 0.0005), CGI/S (P < 0.0005), and CGI/C (P < 0.0005) scores vs. prior lithium. There was no difference in mean YMRS scores between treatment conditions (P = 0.179).
Venlafaxine monotherapy may be a safe and effective monotherapy of BP II MDE with a low hypomanic conversion rate in lithium non-responders.

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    • "With a maximum recommended dosage of 375 mg, it is prescribed for a range of conditions, including major depression , generalized anxiety, social anxiety, and panic disorder (Bakish, 1999; Silverstone and Ravindran, 1999; Gorman et al., 2000; Thase et al., 2000; Thase et al., 2001; Anderson et al., 2008). Its off-label prescription has been reported as well in fibromyalgia (Sayar et al., 2003), tension-type headache (Zissis et al., 2007), migraine prophylaxis (Ozyalcin et al., 2005), cocaine dependence (McDowell et al., 2000), and a range of other conditions (Findling et al., 1996; Gelenberg et al., 2000; Freeman et al., 2001; Galvez et al., 2004; Rowbotham et al., 2004; Evans et al., 2005; Amsterdam et al., 2010). Venlafaxine is available either as an immediate-release (tablet) or as an extended-release formulation (venlafaxine XR capsule and tablet; Wellington and Perry, 2001). "
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    ABSTRACT: Introduction Venlafaxine is one of the most frequently prescribed antidepressants worldwide, despite its toxicity risk in overdose. Furthermore, the molecule has been recently identified at the EU-wide level as one of the novel psychoactive substances. This paper aims at investigating the potential of misuse, taking into account both the existing literature and the analysis of the misusers' experiences as described in venlafaxine misuse web reports. Methods A literature search was performed using PubMed, Embase, and Medline. Posts/threads relating to venlafaxine misuse issues were identified through Google® and Yahoo® English-language searches. Resulting websites' data were then qualitatively assessed, and information was collected on a range of issues, including dosage, drug intake modalities, untoward drug effects, and association with other recreational drugs. Results A few literature case reports focusing on venlafaxine as a misusing drug were here identified. The molecule was here typically ingested or snorted at dosages up to 10–15 times higher than those clinically advised, obtaining MDMA/amphetamine-like stimulant and psychedelic effects. Polydrug misuse was commonly reported. Venlafaxine appeared to be widely available online for sale. Conclusions Physicians should carefully evaluate patients for history of drug dependence and observe them for signs of venlafaxine misuse.
    Human Psychopharmacology Clinical and Experimental 07/2015; 30(4):255-261. DOI:10.1002/hup.2476 · 2.19 Impact Factor
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    • "No studies on the efficacy of mirtazapine for bipolar disorder exist. Concerning venlafaxine, its efficacy in the treatment of bipolar II depression has been shown in small sample sizes only [33-35] and one study shows that venlafaxine may trigger switches to mania [36]. Recent reviews and studies on the efficacy of antidepressants alone or in combination in the treatment of bipolar depression do not find stable effects for their efficacy [37-42]. "
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    ABSTRACT: Background For the pharmacological treatment of bipolar depression several guidelines exist. It is largely unknown, to what extent the prescriptions in daily clinical routine correspond to these evidence based recommendations and which combinations of psychotropic drugs are frequently used. Methods The prescriptions of psychotropic drugs were investigated of all in-patients with bipolar depression (n = 2246; time period 1994–2009) from hospitals participating in the drug surveillance program AMSP. For the drug use in 2010, 221 cases were analysed additionally. Results From 1994 to 2009, 85% of all patients received more than one class of psychotropic substances: 74% received antidepressants in combination therapy, 55% antipsychotics, 48% anticonvulsants and 33% lithium. When given in combination, lithium is the most often prescribed substance for bipolar depression (33%), followed by valproic acid (23%), mirtazapine and venlafaxine (16% each), quetiapine (15%), lamotrigine (14%) and olanzapine (13%). Both, lithium and valproic acid are often combined with selective serotonin reuptake inhibitors (SSRI), but also with mirtazapine und venlafaxine. Combinations of more than one antidepressant occur quite often, whereby combinations with bupropion, paroxetine, fluoxetine or fluvoxamine are very rare. In 2010, quetiapine (alone and combined) was the most frequently prescribed drug (39%); aripiprazole was administered in 10%. Conclusion Combinations of antidepressants (SSRI, mirtazapine, venlafaxine) with mood stabilizers (lithium, valproic acid, lamotrigine) and / or atypical antipsychotics (quetiapine, olanzapine) are common. Of most of those combinations the efficacy has not been studied. The use of aripiprazole and the concomitant use of two or three antidepressants contrast the guidelines.
    BMC Psychiatry 09/2012; 12(1). DOI:10.1186/1471-244X-12-153 · 2.21 Impact Factor
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    • "A secondary analysis of the data showed no difference in treatment response between rapid and nonrapid cyclers [18]. Switch to venlafaxine treatment for lithium nonresponders resulted in a significant improvement in depressive symptoms, with no evidence of manic induction over a follow-up period of 12 weeks [19]. Another smaller study of fifteen depressed female patients with a diagnosis of BPII disorder corroborated these findings, demonstrating no episodes of drug-induced mania or hypomania during 6 weeks of venlafaxine monotherapy [20]. "
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    ABSTRACT: While studies in the past have focused more on treatment of the manic phase of bipolar disorder (BD), recent findings demonstrate the depressive phase to be at least as debilitating. However, in contrast to unipolar depression, depression in bipolar patients exhibits a varying response to antidepressants, raising questions regarding their efficacy and tolerability. Methods. We conducted a MEDLINE and Cochrane Collaboration Library search for papers published between 2005 and 2011 on the subject of antidepressant treatment of bipolar depression. Sixty-eight articles were included in the present review. Results. While a few studies did advocate the use of antidepressants, most well-controlled studies failed to show a robust effect of antidepressants in bipolar depression, regardless of antidepressant class or bipolar subtype. There was no significant increase in the rate of manic/hypomanic switch, especially with concurrent use of mood stabilizers. Prescribing guidelines published in recent years rely more on atypical antipsychotics, especially quetiapine, as a first-line therapy. Conclusions. Antidepressants probably have no substantial role in acute bipolar depression. However, in light of conflicting results between studies, more well-designed trials are warranted.
    Depression research and treatment 01/2012; 2012(6):684725. DOI:10.1155/2012/684725
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