Nimodipine monotherapy and carbamazepine augmentation in patients with refractory recurrent affective illness.
Of 30 patients with treatment-refractory affective illness, 10 showed a moderate to marked response to blind nimodipine monotherapy compared with placebo on the Clinical Global Impressions Scale. Fourteen inadequately responsive patients (3 unipolar [UP], 11 bipolar [BP]) were treated with the blind addition of carbamazepine. Carbamazepine augmentation of nimodipine converted four (29%) of the partial responders to more robust responders. Patients who showed an excellent response to the nimodipine-carbamazepine combination included individual patients with patterns of rapid cycling, ultradian cycling, UP recurrent brief depression, and one with BP type II depression. When verapamil was blindly substituted for nimodipine, two BP patients failed to maintain improvement but responded again to nimodipine and remained well with a blind transition to another dihydropyridine L-type calcium channel blocker (CCB), isradipine. Mechanistic implications of the response to the dihydropyridine L-type CCB nimodipine alone and in combination with carbamazepine are discussed.
Pazzaglia
P J
PJ
Biological Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892-1272, USA.
Post
R M
RM
Ketter
T A
TA
Callahan
A M
AM
Marangell
L B
LB
Frye
M A
MA
George
M S
MS
Kimbrell
T A
TA
Leverich
G S
GS
Cora-Locatelli
G
G
Luckenbaugh
D
D
D000328:Adult; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000009:adverse effects; D002220:Carbamazepine / Q000008:administration & dosage* / Q000009:adverse effects; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D017275:Isradipine / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage* / Q000009:adverse effects; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
D018692:Antimanic Agents; D002121:Calcium Channel Blockers; D002220:Carbamazepine; D009553:Nimodipine; D017275:Isradipine