An Open Trial of Adjunctive Escitalopram in Bipolar Depression

Manoela Fonseca, M.D.; Jair C. Soares, M.D.; John P. Hatch, Ph.D.;Aida P. Santin, M.D.; and Flavio Kapczinski, M.D., Ph.D.

Objective: This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonergic antidepressant, escitalopram, in the treatment of bipolar depression.

Method: Twenty outpatients with DSM-IV bipolar depression types I and II were enrolled in a 12-week open trial of escitalopram, 10 mg daily, adjunctive to their ongoing mood stabilizer. Assessments were carried out using the Hamilton Rating Scale for Depression (HAM-D), the Young Mania Rating Scale (YMRS), and the Clinical Global Impressions for Severity (CGI-S) and Improvement (CGI-I) scales. The study was conducted from August 2003 to February 2004.

Results: Escitalopram was associated with significant improvement as measured by the HAM-D total score, which showed a mean reduction from baseline (mean = 20.9, SD = 4.2) to endpoint (mean = 8.9, SD = 3.6; p < .001) of 12 points. The mean CGI-S score decreased by 3.3 points (baseline: mean = 4.8, SD = 0.7; week 12: mean = 1.5, SD = 0.6; p < .001). Adverse events emerged in 75% of the patients (N = 15), usually of mild-to-moderate severity. Four dropouts took place due to manic switch (N = 1), hypomanic symptoms (N = 2), and hospitalization due to the emergence of suicidal ideation and psychosis (N = 1).

Conclusion: These findings suggest that escitalopram in association with mood stabilizers may be an effective and reasonably well-tolerated treatment for patients with moderate-to-severe bipolar depression. The switch rate was similar to what is described in the literature for the selective serotonin reuptake inhibitors. Randomized controlled trials of escitalopram in bipolar depression are warranted.

(J Clin Psychiatry 2006;67:81-86)

Received Feb. 1, 2005; accepted Dec. 1, 2005. From the Psychiatry Research Unit, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Drs. Fonseca and Kapczinski); the MOOD-CNS Program, Division of Mood and Anxiety Disorders, the Department of Psychiatry, the University of Texas Health Science Center at San Antonio (Drs. Fonseca, Soares, and Hatch); the Psychiatry Service, South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, Tex. (Drs. Fonseca and Soares); the Psychiatry Service, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil (Drs. Fonseca, Santin, and Kapczinski); and the Department of Orthodontics, The University of Texas Health Science Center at San Antonio (Dr. Hatch).

This work was partly supported by a grant from Fundo de Incentivo à Pesquisa e Eventos-Hospital de Clínicas de Porto Alegre (FIPE-HCPA), Brazil. Samples of escitalopram (Lexapro) were supplied by Lundbeck Brasil Ltda, Rio de Janeiro, Brazil.

The authors report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Manoela Fonseca, M.D., Department of Psychiatry, Division of Mood and Anxiety Disorders, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900 (e-mail: fonsecam2@uthscsa.edu).