Connie M. Strong

Divalproex therapy in medication-naive and mood-stabilizer-naive bipolar II depression.

BACKGROUND There have been few systematic studies of the treatment of bipolar II depression. While divalproex sodium (DVPX) is effective in acute mania, there are few data on the antidepressant effects of DVPX. Similarly, little is known regarding the use of DVPX administered in a single daily dose. METHOD We performed a 12-week open trial of DVPX monotherapy (mean dose 882 mg qhs, mean level 80.7 mug/ml) in nineteen (thirteen women, six men, mean age 29) bipolar II depressed outpatients. Eleven patients (six women, five men) were medication-naive (MN) and eight (seven women, one man) were mood stabilizer-naive (MSN), having had prior trials of antidepressants or stimulants. Mean illness and current depressive episode duration were 15.4 years and 11.8 weeks, respectively. DVPX was given as a single dose each evening starting with 250 mg at bedtime and increased by 250 mg at bedtime every 4 days until symptom relief or adverse effects were noted. Weekly prospective Hamilton Depression, Young Mania and Clinical Global Impression ratings were obtained. RESULTS DVPX therapy was generally well tolerated. Twelve of nineteen patients (63%) responded (>50% decrease in Hamilton Depression ratings). MN patients compared to MSN patients tended to have a higher response rate (9/11 versus 3/8, P<0.08). Mean Hamilton scores decreased from 22.2 to 9.6 (P<0.0001) in the entire group, from 20.6 to 6.6 (P<0.0003) in MN patients, and from 24.2 to 14.7 (P=0.008) in MSN patients. CONCLUSION Single daily dose DVPX monotherapy appeared to be well tolerated and substantially benefited 63% of patients with bipolar II depression. The trend towards a higher rate of antidepressant response to DVPX in MN patients (82%) compared to MSN patients (38%) could be due to a milder form or earlier phase of illness and the lack of prior medication exposure or failures. This uncontrolled open pilot study must be viewed with caution, and randomized double-blind placebo controlled studies of DVPX in bipolar II depression are warranted to confirm the possibility that single daily dose DVPX is an effective, well-tolerated, first-line monotherapy in this population.

Toward interaction of affective and cognitive contributors to creativity in bipolar disorders: A controlled study

BACKGROUND Enhanced creativity in bipolar disorder patients may be related to affective and cognitive phenomena. METHODS 32 bipolar disorder patients (BP), 21 unipolar major depressive disorder patients (MDD), 22 creative controls (CC), and 42 healthy controls (HC) (all euthymic) completed the Revised Neuroticism Extraversion Openness Personality Inventory (NEO), the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), the Myers-Briggs Type Inventory (MBTI); the Barron-Welsh Art Scale (BWAS), the Adjective Check List Creative Personality Scale, and the Figural and Verbal Torrance Tests of Creative Thinking. Mean scores were compared across groups, and relationships between temperament/personality and creativity were assessed with bivariate correlation and hierarchical multiple linear regression. RESULTS BP and CC (but not MDD) compared to HC had higher BWAS-Total (46% and 42% higher, respectively, p<0.05) and BWAS-Dislike (83% and 93% higher, p<0.02) scores, and higher MBTI-Intuition preference type rates (78% vs. 50% and 96% vs. 50%, p<0.05). BP, MDD, and CC, compared to HC, had increased TEMPS-A-Cyclothymia scores (666%, 451% and 434% higher, respectively, p<0.0001), and NEO-Neuroticism scores (60%, 57% and 51% higher, p<0.0001). NEO-Neuroticism and TEMPS-A Cyclothymia correlated with BWAS-Dislike (and BWAS-Total), while MBTI-Intuition continuous scores and NEO-Openness correlated with BWAS-Like (and BWAS-Total). LIMITATIONS Relatively small sample size. CONCLUSIONS We replicate the role of cyclothymic and related temperaments in creativity, as well as that of intuitive processes. Further studies are needed to clarify relationships between creativity and affective and cognitive processes in bipolar disorder patients.

277. Open adjunctive gabapentin effective in bipolar depression

resolved during euthymia and hypomania in a case report of a rapid cycling bipolar disorder patient. Facial emotion recognition has not been extensively studied in groups of manic and euthymic patients compared to healthy controls. Seven manic (YMRS . 20) bipolar I and eight euthymic bipolar II disorder patients, and six healthy controls matched (1) Ekman’s Pictures of Facial Affect (EPFA) to descriptors of six basic emotions (fear, anger, surprise, disgust, sadness, happiness); (2) EPFA to one another for facial emotion; and (3) Benton Facial Recognition photographs to one another for identity. On task (1), manic patients’ scores for “fear” were lower than euthymic patients and healthy controls. Manic patients compared to controls (but not compared to euthymic patients) also had decreased scores for 4/5 (anger, surprise, disgust, and sadness, but not happiness) of the other basic emotion descriptors. Euthymic patients did not differ significantly from controls. Task (2) showed similar results, while on task (3), there were no significant between-group differences. Thus, manic patients had impaired facial fear recognition compared to both controls and euthymic bipolar II patients, and impaired facial sadness (but not happiness) recognition compared to controls. It remains to be determined whether these differences are due to the manic state or the bipolar I disorder trait. Euthymic bipolar II patients did not have facial emotion recognition deficits, in contrast to prior studies in depressed patients.