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Because the social disruption may be minimal, and some of the symptoms may even seem beneficial, past episodes of hypomania may be ignored or dismissed by the patient and family. Sachs and colleagues3 sought to determine whether adding an antidepressant to a mood stabilizer (lithium or an antiepileptic) reduced symptoms of bipolar depression without increasing the risk of mania.
Leverich and colleagues12 randomized bipolar depressed patients to a mood stabilizer plus either bupropion, sertaline, or venlafaxine.
Thus, the emerging consensus based on expert opinion9,14 published guidelines,15-17 and the STEP-BD reports12,13 is that mood stabilizers are preferable both for acute treatment and the prevention of recurrence in late-life bipolar depression. Evidenced-based psychosocial interventions for bipolar depression have grown in number and sophistication but mainly focused on younger rather than older adults. In individual CBT, patients and therapists discussed behavioral activation exercises, problem solving, and cognitive restructuring, all meant to reverse negative self attributions and increase rewarding habits. With the increase in the older adult population, primary care physicians and general psychiatrists will inevitably encounter the paradox and challenge of late-life bipolar depression. E-newsletter Opt-inSent no more than 2–3 times each month, our E-Newsletter brings you recent findings and commentary from the psychiatric literature. Several groups of active substances can raise the blood pressure slightly, can relieve the complaints of low blood pressure and can prevent the dizzy spells. The potential side-effects include, among other things, heart hurry, heart rhythm disorders and bladder emptying disorders. This group includes etilefrine, ameziniummetilsulfate, midodrine, norfenefrine, pholedrine and oxilofrine. Fludrocortisone is a synthetically produced hormone of the adrenal cortex (mineralocorticoid). Erythropoietin (epoietin alpha or epoietin beta) is a hormone which stimulates the maturation of the red blood cells (erythrocytes) in the bone marrow. Cocoa extracts could help prevent Alzheimer’s disease and may eventually come in chocolate form, according to a leading neurology doctor. These extracts, which contain polyphenols, could help reduce age-related cognitive dysfunction and promote better aging of the brain, according to Dr.
In addition to his work with cognitive disorders and chocolate, Pasinetti said he is working toward a collaborative effort with the US Department of Defense to develop a compound for brain injury and post-traumatic stress disorder. In addition, he noted that Mars already has Cocoavia on the market, a pill rich in flavanol said to be cognitively beneficial.By collaborating further, the communities can together ensure that the lack of consistency and reproduction of cocoa extract processing can be addressed in full, as there are concerns about the long-term supply and quality of cocoa. There may need to be new breeds of cocoa grown that are specifically created to be fruitful and resistant to disease. Get FREE access to authoritative breaking news, videos, podcasts, webinars and white papers.
From botanicals to omega 3s, Millennials want products that include particular ingredients or meet specific requirements.
Kennedy is professor in the Department of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine, and director of the Division of Geriatric Psychiatry at Montefiore Medical Center in the Bronx, New York.
Kennedy has received research support or honoraria from AstraZeneca, Eli Lilly, Forest, Janssen, Myriad, and Pfizer.
It is a challenge because persistent disability and recurrence are common, and a paradox because antidepressants appear to be counterproductive.
Associated symptoms include grandiosity or inflated self-regard, decreased need for sleep, loquaciousness or pressured speech, flight of ideas, racing thoughts, distractibility, agitation, increased goal-directed activity, and increased pursuit of pleasures with high self-destructive potential.
MDEs also occur in bipolar disorder type I in which the occurrence of one or more manic episodes is the distinguishing diagnostic feature. Perlis and colleagues5 prospectively assessed potential predictors of recurrent mood disturbance among 858 symptomatic patients who subsequently recovered from an episode of bipolar disorder.
Table 1 displays the agents suitable for older adults with doses, precautions, and therapeutic levels. They were also interested in the durability of recovery defined as a minimum of 8 weeks virtually free of depressive symptoms.
Nierenberg and colleagues11 examined 66 bipolar patients in a current MDE who had not responded to adequate doses of mood stabilizers and at least one antidepressant.
Depending on the agent and whether or not there was a past history of mania, 20% to 35% of patients experienced either treatment-emergent mania or hypomania. An algorithm based on the expert opinions of Hilty and colleagues17 and Dolder and colleagues18 appears in the Figure.


Intensive psychosocial interventions prevent hospitalization associated with recurrence22,23 and improve functional recovery.24 As implemented in the STEP-BD study, patients were randomized to collaborative care or one of thee intensive psychosocial interventions applied in three 30-minute sessions. In ISRT, interpersonal problems and difficulties maintaining a physiologically stable schedule of sleep, waking, and activity were examined with a goal of preventing destabilizing social and interpersonal situations. Data from the older adult segment of the STEP-BD study will add considerably to the empirical basis for treatment.
The clinical features of bipolar depression: a comparison with matched major depressive disorder patients. Predictors of recurrence in bipolar disorder: primary outcomes from the systematic Treatment Enhancement Program for Bipolar Disorders (STEP-BD). Cognitive functioning and instrumental activities of daily living in late-life bipolar disorder.
Double-blind, placebo controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. However, all drug-induced therapies may cause undesired actions (such as high blood pressure, for example).
Similar to the body’s own messengers adrenaline and noradrenaline; they increase the return flow of the blood to the heart and stimulate the heartbeat. Sympathomimetic agents must not be used in case of coronary heart disease, glaucoma, enlargement of the prostate gland, thyroid hyperfunction, during the first third of pregnancy and in professional sports (positive doping test). In the kidney it prevents the excretion of salt and water, thus causing the blood volume and hence the blood pressure to increase. This action improves the return flow of the blood to the heart and prevents circulation problems when standing up. Already, he said there are companies driving research, such as Nestle, which is investigating cocoa's relationship to Alzheimer’s disease.
Giulio Maria Pasinetti, Saunders Family Chair and Professor of Neurology at the Icahn School of Medicine at Mount Sinai in New York.
Although bipolar depression in late life is not common, the increasing number of older people in the population insures that primary care providers will confront the paradox.
The symptoms represent an unequivocal, uncharacteristic, and socially disruptive change in behavior. And there are mixed states in which criteria for both mania and major depression are present. Ziprasidone and chlorpromazine were omitted due to cardiovascular hazards despite FDA approval for bipolar disorder. Patients were randomized to receive a mood stabilizer plus either an antidepressant or placebo. In an open-label study, the patients were randomly assigned to inositol, lamotrigine, or risperidone. In less than 25% of patients was there a sustained response to the antidepressant without a switch into mania or hypomania.
People in the collaborative care condition received a self-care workbook, viewed an educational videotape, and were counseled on sleep monitoring and relapse prevention.
For people with at least one family member willing to participate, FFT focused on shared planning for relapse prevention, improved listening and communication, and problem solving skills. Results from the Geriatric Bipolar Disorder study of late-life mania25,26 should provide guidance on the benefit versus burden comparison of lithium to divalproex for bipolar depression as well.
Treatment-resistant bipolar depression: a STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotriginne, inositol, or risperidone. Risk of switch on mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers.
Adjunctive antidepressant use and symptomatic recovery among bipolar depressed patients with concomitant manic symptoms; findings from the STEP-BD. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the systematic treatment enhancement program. Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial.
A double-blind placebo-controlled study of lamotrigine in outpatients with bipolar I depression.


Efficacy of quetiapine monotherapy in bipolar I and II depression: a double blind, placebo-controlled study (the BOLDER II study). Atypical antipsychotics in the treatment of mania: a meta-analysis of randomized, placebo-controlled trials. For this reason, you should try to reduce the complaints of low blood pressure by non-medicinal measures first of all. Fludrocortisone is applied to patients primarily who have circulation problems when standing up and do not develop an increase in pulse for compensation (asympathicoton orthostatic hypotension).
For this reason dihydroergotamine is applied primarily in case of sympathicoton orthostatic hypotension, the most frequently circulatory trouble which leads to circulation-induced falls (syncopes). In patients suffering from severe orthostatic hypotension, who do not respond to other drugs, erythropoietin may reduce the complaints.
As the ability to strengthen cocoa development grows, he believes they will better be able to promote healthy aging of the brain and even fully prevent Alzheimer’s disease.“It’s an opportunity that we can create a chocolate that can eventually be consumed just in the regular diet,” he said, adding that the great hope is that it can be used regularly to quell these cognitive and nervous system disorders. Data from the older adult segment of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study have yet to emerge, but a review of published studies offers considerable guidance. The absence of psychosis and severe social impairment and the duration of symptoms less than one week distinguish hypomania from the mania of bipolar disorder type I.
Rates of treatment-emergent mania or hypomania were less among the mood stabilizer-only group. Beyond the initial step of prescribing either lithium or lamotrigine, next steps are dictated by the patient’s symptom profile.
The intensive psychosocial interventions included cognitive-behavioral therapy (CBT), interpersonal and social rhythms therapy (ISRT), and family-focused treatment (FFT). In the meanwhile, inferences based on guidelines,15-17 the STEP-BP publications,12,13,22 and others27-29 provide considerable guidance for both biomedical and psychosocial interventions.
A combination of one or more mood stabilizers plus aggressive psychosocial intervention offers hope of more effective treatment. This broad rather heterogenous definition may explain why the array of proven treatments, especially for older patients, remains limited. The proportion of days depressed or anxious in the preceding year as well as residual symptoms of depression or mania at recovery predicted a subsequent depressive episode. Similarly, slightly more than one quarter of those in the mood stabilizer-only group experienced a durable recovery compared to slightly less than one quarter among those who received an antidepressant as well. Although pair-wise comparisons did not reach statistical significance, the recovery rate, level of depressive symptoms, Clinical Global Impression, and Global Assessment of Functioning all favored lamotrigine. Goldberg and colleagues13 also tested the adjunctive antidepressant hypothesis among bipolar patients with mixed mania and depression.
For episodes of depression in both bipolar types I and II where the patient’s history exhibits relatively less mania, the antidepressant bupropion is a reasonable addition. Proportion of days with elevated mood in the preceding year as well as residual symptoms of mania were associated with a shorter time to the recurrence of a manic, mixed, or depressive episode.
Even so, slightly less than one quarter of the lamotrigine group experienced a durable recovery. They found significantly higher mania symptom severity after 3 months of follow-up associated with antidepressant therapy compared to mood stabilizers alone. However, for instances characterized by mixed symptoms or more frequent episodes of mania, an atypical antipsychotic or a second mood stabilizer is advisable. For people who remain symptomatic despite reaching adequate dose or therapeutic level, ongoing adjunctive therapy with a second mood stabilizer or an atypical antipsychotic may be superior to the addition of an antidepressant. Impairments in cognitive speed and executive dysfunction6,7 and changes in subcortical brain structures are common,8 further reducing the chances of return to full function. Thus, prescription on adjunctive treatment with an antidepressant conveyed no advantage above that observed for a mood stabilizer alone. Purely on the basis of side-effect profile and likelihood of drug interactions, lamotrigine would appear to be preferable to lithium, divalproex, and carbamazepine. Nonetheless, people with little or no history of mania may still benefit from an antidepressant.




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