This indicates that 5 patients would require treatment with quetiapine in order for 1 additional patient to achieve a response as compared with placebo. Data from other large bipolar depression trials

reveal the NNT values to be 12 for olanzapine (95% CI, 7-62), 4 for OFC (95% CI, 3-8), and 4 for lamotrigine 200 mg/d (95% CI, 3-1 0). However, as the four negative trials with lamotrigine Inhibitors,research,lifescience,medical had not yet been released at the time of this analysis, the true NNT for lamotrigine is likely to be much higher. It should also be noted that the NNT may vary according to the baseline clinical and demographic profile of the enrolled subjects. Thus, crossstudy comparisons should be interpreted with caution. Treatment-refractory bipolar depression Our review identified only Inhibitors,research,lifescience,medical one randomized trial that,

evaluated pharmacological agents for the relief of treatmentresistant bipolar depression.42 This study assessed the adjunctive benefit, of adding open inositol, lamotrigine, or risperidone to Inhibitors,research,lifescience,medical conventional mood stabilizers. Criteria for treatment-resistant depression, defined as being nonresponsive to a mood stabilizer plus one or two antidepressant trials during a major depressive episode, was met by each of the 66subjccts.Afterupto 16weeks of treatment, no difference in the rate of recovery (8 weeks of ≤ 2 DSMIV threshold criteria for a major depressive, manic, or hypomanic episode) was 2-MeOE2 mw observed for subjects taking lamotrigine (24%), inositol (17%), Inhibitors,research,lifescience,medical or risperidone (5%). Maintenance

treatment of bipolar depression Upon achieving an acute antidepressant, response in bipolar disorder, the conventional wisdom is to maintain the drug regimen which resulted in initial symptom reduction. An exception to this tenet involves Inhibitors,research,lifescience,medical the use of conventional antidepressants, where some authors have argued for antidepressant discontinuation after approximately 6 months of use in order to avoid cycle acceleration or induction of mood switches above baseline.43 The negative STEP-BD data now call into question the entire practice of Vasopressin Receptor using antidepressants in either the acute or continuation phase treatment of bipolar depression, and unexpectedly do not suggest, that, antidepressants promote treatment-emergent affective switch. As this trial did not extend beyond 26 weeks, maintenance trials in the magnitude of 1 to 2 years are necessary to explicate the long-term efficacy and safety profile of antidepressant administration. Disappointingly, there are few trials that address maintenance phase outcomes in bipolar disorder. For example, there are no placebo-controlled maintenance studies of selective serontonin uptake inhibitors (SSRIs), bupropion, or serotonin-norepinephrine uptake inhibitors (SNRIs) in bipolar depression.