Early Improvement of Symptoms in Bipolar 1 Depression

CONFERENCE REPORTER

In this Mental Health Minute, Anita H. Clayton, MD, joins Psychiatric Times® live from the 2024 American Society of Clinical Psychopharmacology (ASCP) Annual Meeting and gives us a preview of her upcoming poster presentation, “Early Improvement of Symptoms in Bipolar I Depression Predicts Functional Remission and Recovery: A Post-Hoc Analysis,” which outlines new research by Roger S. McIntyre, MD, FRCPC, et al. The full transcript is below.

I am Anita Clayton. I am professor and chair of psychiatry and neurobehavioral sciences at the University of Virginia. I am also professor of clinical obstetrics and gynecology in the UVA School of Medicine.

This poster is looking at rapid improvements as a predictor of functional recovery and remission, and it is looking at cariprazine vs placebo. The 2 doses of cariprazine are 1.5 milligrams per day, with a titration to 1.5 before week 2 and the people randomized to the 3 mg of cariprazine were 1.5 until the end of week 2, when they went to 3 mg. It was an 8-week trial.

The instruments that were used are the Hamilton Depression Rating Scale (HAM-D), looking at the anxiety somatization score, and the Montgomery and Åsberg Depression Rating Scale (MADRS) total score, looking at depression and also looking at the anhedonia subscale with the MADRS.

I think it is really exciting if we can see early improvements that inform us that this person will actually go on to achieve remission and functional recovery, as opposed to feeling like we have to wait 6 to 8 weeks before we know if we should change medications or not.

These are bipolar 1 patients in a depressive episode—so often, we do not always know that what we give them will lead them to be stable in terms of their mood. So, it is pretty critical to get patients with bipolar 1 into remission quickly.

I think another thing about bipolar 1 and bipolar 2 that we need to think about is getting the diagnosis correct and appropriate, so that we know the right treatments. And things like family history of bipolar illness: I have seen recently in some cases of patients where this was never mentioned, but the grandmother had been on lithium for 40 years, the mother had also been on lithium for bipolar illness, and the granddaughter had been diagnosed with treatment-resistant depression.

Twenty percent of patients with bipolar depression do not respond to SSRIs, and they do not become manic with SSRIs. So, we really need to get the diagnosis right, and if someone is not responding, we need to revisit the diagnosis.

Dr Clayton is chair of psychiatry and neurobehavioral sciences and professor of clinical obstetrics and gynecology at the University of Virginia. She has published more than 200 peer-reviewed papers and was named to the 2019-2020 Best Doctors in America list.

Follow the Psychiatric Times coverage of the 2024 ASCP Annual Meeting, and stay up-to-date on news related to research on promising new interventions and developments in the treatment of a wide variety of psychiatric disorders, at psychiatrictimes.com.