Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

180 A. Koukopoulos et al.Table 7.4 Treatments associated with full improvement of mixed depressionepisodes (n ¼ 120)Electroconvulsive therapy 51Neuroleptic 40Antiepileptics 40Lithium 38Olanzapine 22Benzodiazepines 30OutcomeOne hundred and twenty patients (57%) fully recovered. Forty-two patients (20%)showed partial improvement demonstrated by a mean Hamilton-D score of 11(range 9–15). Fifty (23%) patients did not improve significantly and four of thesepatients committed suicide.Treatment with olanzapineWe have found olanzapine to be particularly effective in the treatment of agitateddepression. Thirty-three patients were treated with olanzapine at a mean dailydose of 5.5 mg (range 2.5–15 mg). Twenty-two patients (67%) recovered fully, five(15%) recovered partially, and six (18%) did not improve. The therapeutic delayof olanzapine was short, with a mean of 7.65 days (range 1–30 days; SD ¼ 6.67).Three cases improved substantially within 24 h.Olanzapine was administered alone in nine cases. In the remaining casesbenziodiazepines or anticonvulsants were added. Our observations about theeffectiveness and speed of action of olanzapine in similar cases confirm earlierreports (Parker, 2002). Parker and Malhi (2001) advance the hypothesis thatatypical antipsychotics may have an antidepressant effect, particularly intreatment-resistant melancholic depression, and suggest the term atypical antidepressants.We maintain, as explained above, that the antidepressant effect is dueto the antimanic action of these agents in cases of depression of a mixed nature.Agitated depression followed by simple depressionIn many cases the resolution of the psychic agitation also swiftly brings to an endthe depressive symptoms. In other cases, especially those with motor agitation orpsychotic features, a phase of simple, more or less inhibited depression follows.