Effectiveness of Lithium and Valproate in Treating High-Risk Bipolar Disorder

NCT ID: NCT00563992

Last Updated: 2012-05-01

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1
• Total Enrollment: 98 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2001-01-31
• Study Completion Date: 2008-10-31

Brief Summary

This study will evaluate the effectiveness of two different mood stabilizing medications, lithium and valproate, in treating people with bipolar disorder and suicidal behavior.

Detailed Description

Bipolar disorder, also called manic-depressive illness, is a brain disorder that causes dramatic changes in a person's mood and energy. Bipolar disorder normally forms in late adolescence or early adulthood and requires treatment for the rest of a person's life. People with bipolar disorder undergo periods of extreme happiness and extreme sadness, known as episodes of mania and depression. Symptoms of mania can include increased energy, euphoric moods, mind racing, aggressive behavior, substance abuse, and poor decision making. Symptoms of depression can include persistent feelings of anxiety, guilt, or hopelessness; irregular sleep and appetite patterns; lethargy; disinterest in previously enjoyed activities; excessive irritability and restlessness; and inability to concentrate. Some people with bipolar disorder also become suicidal. Suicidal behaviors are more likely to occur at the onset of the illness, making it vital to recognize and treat the disorder early on. Current treatments include mood stabilizing medications and psychotherapy. This study will evaluate the effectiveness of two different mood stabilizing medications, lithium and valproate, in treating people with bipolar disorder and suicidal behavior.

Participants in this double-blind study will be randomly assigned to take one of two medications, either lithium or valproate. In the first 2 to 6 months, depending on clinical condition, participants may also be required to take the antidepressant paroxetine and/or the medication olanzapine. Participants will attend regular visits to a psychiatrist or a psychologist at the Neuroscience Clinic. A blood sample will be taken at each visit to monitor medication blood levels. Participants will also undergo periodic routine laboratory and urine tests to assure their safety.

If the psychiatrist feels improvement has occurred by the end of the 2- to 6-month period, participants will be gradually taken off paroxetine and/or olanzapine over a 2-week period. They will then continue taking the assigned lithium or valproate for the remainder of the study. If the psychiatrist feels the condition has worsened, participants will be prescribed new medications as needed. These medications include other antidepressants (bupropion or venlafaxine) or other antimanic or antipsychotic drugs (perphenazine or haloperidol). Once these participants have achieved at least 2 weeks of normal moods, they will be gradually taken off all other prescribed medications and will remain taking the assigned lithium or valproate. Participants who do not achieve at least 2 weeks of normal moods will stop study participation but will still be offered clinical treatment. The remaining participants taking only lithium or valproate will continue their regular visits with a psychiatrist for the last 6 months of the study. The entire study will last 12 months.

Conditions

Bipolar Disorder

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

1

Participants will take lithium for 12 months

Group Type: EXPERIMENTAL

Lithium

Intervention Type: DRUG

Participants may also be required to take the antidepressant paroxetine and/or the medication olanzapine for a portion of the study.

2

Participants will take valproate for 12 months

Group Type: EXPERIMENTAL

Valproic acid

Intervention Type: DRUG

Participants may also be required to take the antidepressant paroxetine and/or the medication olanzapine for a portion of the study.

Interventions

Lithium

Participants may also be required to take the antidepressant paroxetine and/or the medication olanzapine for a portion of the study.

Intervention Type: DRUG

Valproic acid

Participants may also be required to take the antidepressant paroxetine and/or the medication olanzapine for a portion of the study.

Intervention Type: DRUG

Other Intervention Names

Sodium valproate or valproic acid (Depakote)

Eligibility Criteria

Inclusion Criteria

• Current major depressive episode or mixed episode
• Bipolar disorder
• History of suicidal behavior

Exclusion Criteria

• Requires detoxification from alcohol or other substances
• Blood pressure greater than 160/90 mm Hg
• Active medical problems
• Requires long-term antipsychotic maintenance
• Becomes manic on mood stabilizers and antidepressants
• Contraindication to the use of lithium 1 or valproate (including failure to respond)
• Failure to respond to adequate trials of paroxetine, bupropion, and venlafaxine in the 2 years prior to study entry
• Failure to respond to adequate trials of olanzapine, haloperidol, and perphenazine in the 2 years prior to study entry
• Unable or unwilling to consent to treatment
• Pregnant or lactating

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Mental Health (NIMH)

NIH

Sponsor Role: collaborator

New York State Psychiatric Institute

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Maria A. Oquendo, MD

Role: PRINCIPAL_INVESTIGATOR

Columbia University

Locations

New York State Psychiatric Institute/Columbia University

New York, New York, United States

Countries

United States

Other Identifiers

R01MH059710

Identifier Type: NIH

Identifier Source: secondary_id

View Link

DSIR 83-ATP

Identifier Type: -

Identifier Source: secondary_id

#4973R

Identifier Type: -

Identifier Source: org_study_id