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document
Short-term fluoxetine monotherapy for bipolar type II or bipolar NOS major depression - low manic switch rate . OBJECTIVES Current guidelines for the initial treatment of bipolar type II ( BP II ) major depressive episode ( MDE ) recommend using either a mood stabilizer alone or a combination of a mood stabilizer plus a selective serotonin re-uptake inhibitor ( SSRI ) . This recommendation is the result of concern over antidepressant-induced manic switch episodes . However , recent evidence suggests that the manic switch rate may be low in BP II MDE during SSRI therapy . METHODS As part of a randomized , double-blind , placebo-controlled relapse-prevention study of fluoxetine monotherapy in BP II MDE , 37 patients received open-label fluoxetine 20 mg every day for up to 8 weeks . Outcome measures included the Hamilton Depression Rating ( HAM-D 17 ) rating and the Young Mania Rating ( YMR ) scale . RESULTS Eleven of 23 patients ( 48 % ) who completed 8 weeks of fluoxetine treatment showed a HAM-D 17 reduction of > or =50 % , while 14 ( 38 % ) of all treated patients had > or =50 % reduction in baseline HAM-D 17 score . Using a conservative YMR score of > or =8 to identify hypomanic symptoms , the frequency of patients with YMR score > or =8 during fluoxetine did not differ from that seen during the screen and baseline period . Only three patients ( 7.3 % ) had symptoms suggestive of hypomania , and only one patient stopped treatment because of a rapid mood swing into depression . LIMITATIONS Fluoxetine was given at a fixed dose of 20 mg everyday . Fluoxetine was prescribed in an open-label manner , and the sample size was limited . CONCLUSIONS These observations support the findings of a low manic switch rate during SSRI monotherapy of BP II MDE , and suggest that fluoxetine monotherapy may be a safe and effective initial treatment of BP II MDE .
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Intervention_Pharmacological
fluoxetine monotherapy
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Intervention_Control
placebo-controlled
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Intervention_Physical
fluoxetine monotherapy
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Intervention_Pharmacological
open-label fluoxetine 20 mg
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Intervention_Psychological
every day for up to 8 weeks
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Intervention_Pharmacological
fluoxetine
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Intervention_Pharmacological
Fluoxetine
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Intervention_Pharmacological
Fluoxetine
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Intervention_Pharmacological
fluoxetine monotherapy
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Outcome_Physical
HAM-D 17 reduction
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Outcome_Physical
YMR score of > or =8
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Outcome_Physical
hypomania
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Outcome_Mental
rapid mood swing into depression
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Participant_Condition
bipolar type II or bipolar NOS major depression - low manic switch rate
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Participant_Condition
bipolar type II
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Participant_Condition
BP II
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Participant_Condition
BP II
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Participant_Sample-size
37
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Participant_Condition
BP II MDE