Reduced Suicidal Ideation in Bipolar I Disorder Mixed-Episode Patients in a Placebo-Controlled Trial of Olanzapine Combined With Lithium or Divalproex.
J Clin Psychiatry 2006;67:1246-1252
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To identify symptoms associated with
suicidality in bipolar I disorder patients, and to assess suicide
risk during treatment with olanzapine in combination with lithium
Method: We used data from a study (conducted
from September 1997 to October 2000) in which DSM-IV bipolar I
manic or mixed-episode patients who were partially responsive to
at least 2 weeks of lithium or divalproex monotherapy prior to
study entry were randomly assigned to augmentation therapy with
olanzapine (5-20 mg/day) or placebo. Among mixed-episode patients
with residual suicidality (Hamilton Rating Scale for
Depression-item 3 [HAM-D-3] score of 1 or above) at randomization
to cotherapy, we identified items in the Young Mania Rating
Scale, Positive and Negative Syndrome Scale, and Barnes Akathisia
Rating Scale that correlated with HAM-D-3 scores. We used factor
analysis of correlated items to identify symptom domains
associated with suicidality ratings and assessed changes in
symptom factors and HAM-D-3 scores during 6 weeks of combination
therapy with olanzapine versus placebo.
Results: In 58 mixed-episode patients, mean ± SD
HAM-D-3 scores averaged 1.36 ± 0.55 after at least 2 weeks of
initial mood stabilizer monotherapy prior to study entry. Factors
associated with the HAM-D-3 appeared to represent somatic
discomfort, agitated depression, and psychotic features.
Combination therapy with olanzapine (N = 36) versus placebo (N = 22)
differentially reduced HAM-D-3 scores by 58% versus 29%
(p < .05) within 1 week, and all 3 associated symptom factors
within 2 weeks by averages of 31% versus 12% (p < .05).
Conclusions: Suicidality in adult,
mixed-episode, bipolar I disorder patients was associated with
somatic discomfort, agitated depression, and psychosis. Overall,
these findings suggest that the addition of an atypical
antipsychotic-antimanic agent in some bipolar disorder patients
may help to reduce suicidal ideation.