Psychotherapy for Bipolar II Depression, Pilot Study, Phase II
Trial Snapshot
- Phase
- Phase 2
- Status
- Completed
- Sponsor
- University of Pittsburgh
- Enrollment
- 25
- Locations
- 1
- Primary Endpoint
- Number of Participants With Greater Than or Equal to 50% Reduction in Depression Scores, With a Mania Score Less Than or Equal to 10
Study Overview
Brief Summary
Purpose of this study is to examine the effectiveness of an experimental psychotherapy (talk therapy) for the treatment of bipolar II depression. The name of this psychotherapy is Interpersonal and Social Rhythm Therapy for Bipolar II Depression (IPSRT-BPII). Subjects will be randomly assigned to receive either IPSRT-BPII or the medication Seroquel (quetiapine) to manage their symptoms of bipolar II depression. Subjects will receive the assigned therapy for up to 20 weeks.
Detailed Description
The proposed pilot study is an experimental design intended to investigate the preliminary efficacy of Interpersonal Social Rhythm Therapy for Bipolar II Depression (IPSRT-BPII). A total of 56 eligible subjects with a diagnosis of bipolar II disorder will be randomly assigned to one of two treatment groups : Seroquel (n=28) or IPSRT-BPII (n=28). Following baseline assessment, all participants will undergo up to 20 weeks of their assigned treatment. Patients assigned to IPSRT-BPII who fail to respond (at least 50% reduction in HRSD-25 scores and YMRS ≤ 10) by week 12 will have Seroquel added to IPSRT-BPII. Subjects who achieve remission (defined as 3 consecutive weeks where both HRSD-25 and YMRS scores average ≤ 7) and have participated in the trial for a minimum of 12 weeks will be moved into a continuation phase where they will receive maintenance treatment (bi-monthly therapy sessions and/or pharmacotherapy) until week 20. Patients who do not achieve remission by Week 20 will be discontinued from treatment and referred for follow-up care. All subjects (remitters and non-remitters) will be assessed at 20 weeks.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 65 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Meets DSM-IV Criteria for Bipolar Disorder, Type II, currently depressed;
- •HRSD-25 ≥15
- •Age 18-65 years;
- •Able to give informed consent;
- •Women of child bearing potential will be included if they agree to use adequate contraception for the duration of the study.
Exclusion Criteria
- •Not competent to give informed consent in the opinion of the investigator (e.g., psychotic at time of evaluation);
- •Unwilling or unable to comply with study requirements;
- •Meets DSM-IV criteria for borderline personality disorder or antisocial personality disorder;
- •Active substance abuse within the past 6 months(episodic abuse related to mood episodes will not exclude a subject);
- •Currently a high suicide risk, as assessed by an active plan and intent to behave in a way that risks ending ones life;
- •Non-English speaking;
- •Significant, unstable, medical illness that might confound symptom scores or preclude treatment with pharmacotherapy
- •Currently applying for disability because of psychiatric illness (we have found that these individuals have a vested interested in appearing to remain ill which potentially confounds outcome scores).
- •Women who are pregnant, lactating or plan to become pregnant during their study participation.
Arms & Interventions
Psychotherapy
Subjects randomized to the Psychotherapy arm will receive Interpersonal and Social Rhythm Therapy (IPSRT-BPII)
Intervention: Interpersonal and Social Rhythm Therapy (IPSRT-BPII) (Behavioral)
Medication
Subjects randomized to the medication arm will receive the FDA approved medication Seroquel (quetiapine)
Intervention: Seroquel (Drug)
Outcomes
Primary Outcomes
Number of Participants With Greater Than or Equal to 50% Reduction in Depression Scores, With a Mania Score Less Than or Equal to 10
Time Frame: Week 12
Overall response rates (defined as greater than or equal to 50% reduction in depression scores without an increase in mania scores) were 29% (n=4) in the IPSRT group and 27% (n=3) in the quetiapine group. HRSD-25 scores are based on first 17 responses. Eight items are scored on a 5-pt scale, from 0 (not present) to 4 (severe.) Other nine items on the assessment are scored from 0-2. The higher the score on the HRSD-25, the worse the outcome is considered to be. A score of 0-7 is considered to be normal; 8-13 indicates mild depression, 14-18 indicates moderate depression, 19-22 indicates severe depression, and any score greater than or equal to 23 indicates very severe depression. The YMRS is an 11 point assessment. There are 4 items assessed on a scale ranging from 0 to 8 and the other 7 items are graded on a 0 to 4 scale. As with the HRSD, the higher the score on the YMRS indicates the presence of more or more severe manic symptoms and is associated with a worse outcome.
Secondary Outcomes
- Number of Participants With a Response(Week 12)
- Quality of Life (QOL) Collected Using the Q-LES-Q (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form)(Baseline and Week 12)
- Descriptive Measures of the Feasibility of IPSRT-BPII(Week 12)
Investigators
Holly Swartz
Associate Professor of Psychiatry
University of Pittsburgh