This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.

Original Research

Reduced Suicidal Ideation in Bipolar I Disorder Mixed-Episode Patients in a Placebo-Controlled Trial of Olanzapine Combined With Lithium or Divalproex.

John P. Houston, MD, PhD; Jonna Ahl, PhD; Adam L. Meyers, MS; Christopher J. Kaiser, PhD; Mauricio Tohen, MD; and Ross J. Baldessarini, MD

Published: August 15, 2006

Article Abstract

Objective: To identify symptoms associated withsuicidality in bipolar I disorder patients, and to assess suiciderisk during treatment with olanzapine in combination with lithiumor divalproex.

Method: We used data from a study (conductedfrom September 1997 to October 2000) in which DSM-IV bipolar Imanic or mixed-episode patients who were partially responsive toat least 2 weeks of lithium or divalproex monotherapy prior tostudy entry were randomly assigned to augmentation therapy witholanzapine (5-20 mg/day) or placebo. Among mixed-episode patientswith residual suicidality (Hamilton Rating Scale forDepression-item 3 [HAM-D-3] score of 1 or above) at randomizationto cotherapy, we identified items in the Young Mania RatingScale, Positive and Negative Syndrome Scale, and Barnes AkathisiaRating Scale that correlated with HAM-D-3 scores. We used factoranalysis of correlated items to identify symptom domainsassociated with suicidality ratings and assessed changes insymptom factors and HAM-D-3 scores during 6 weeks of combinationtherapy with olanzapine versus placebo.

Results: In 58 mixed-episode patients, mean ± SDHAM-D-3 scores averaged 1.36 ± 0.55 after at least 2 weeks ofinitial mood stabilizer monotherapy prior to study entry. Factorsassociated with the HAM-D-3 appeared to represent somaticdiscomfort, 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 factorswithin 2 weeks by averages of 31% versus 12% (p < .05).

Conclusions: Suicidality in adult,mixed-episode, bipolar I disorder patients was associated withsomatic discomfort, agitated depression, and psychosis. Overall,these findings suggest that the addition of an atypicalantipsychotic-antimanic agent in some bipolar disorder patientsmay help to reduce suicidal ideation.

Volume: 67

Quick Links:

Continue Reading…

Subscribe to read the entire article


Buy this Article as a PDF