Clozapine therapy in refractory affective disorders: polarity predicts response in long-term follow-up.
BACKGROUND
To determine the efficacy and tolerance of long-term clozapine therapy in refractory affective illness.


METHODS
Hospital records were reviewed for 193 treatment-resistant patients with a discharge diagnosis of bipolar disorder (N = 52), schizoaffective disorder (N = 81), unipolar depression (N = 14), schizophrenia (N = 40), or other disorders (N = 6) started on clozapine therapy as inpatients at McLean Hospital. An independent "best-estimate" diagnosis, based on DSM-III-R criteria, was established for each patient. Patients were contacted at least 6 months after clozapine initiation for structured follow-up interviews by raters blind to diagnosis. Patients were stratified by diagnosis, and a variety of patient characteristics and outcome measures were compared.


RESULTS
Subjects were followed up a mean of 18.7 months after clozapine initiation. Bipolar manic and schizoaffective bipolar subjects had significantly better outcomes than unipolar, bipolar, and schizoaffective depressed patients on a variety of measures. One or more episodes of depression prior to clozapine predicted clozapine discontinuation (p = .01). Affective and schizoaffective subjects had baseline measures of social functioning similar to that of the schizophrenics but had significantly greater improvement in scores at follow-up.


CONCLUSIONS
Clozapine is an efficacious and well-tolerated therapy for refractory affective illness. Manic symptomatology predicts a more favorable response than depression.
Banov
M D
MD
Bipolar and Psychotic Disorders Program, McLean Hospital, Belmont, Mass.
Zarate
C A
CA
Tohen
M
M
Scialabba
D
D
Wines
J D
JD
Kolbrener
M
M
Kim
J W
JW
Cole
J O
JO
D000328:Adult; D000341:Affective Disorders, Psychotic / Q000188:drug therapy* / Q000523:psychology; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology; D003024:Clozapine / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011336:Probability; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D012559:Schizophrenia / Q000188:drug therapy; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D016896:Treatment Outcome
D003024:Clozapine