A new study is evaluating medications used to treat outpatients with bipolar disorder. Referred to as Bipolar CHOICE (Clinical Health Outcomes Initiative in Comparative Effectiveness), the study was launched by the Mood Disorders Program at Case Western Reserve University (CWRU) School of Medicine and University Hospitals Case Medical Center, along with the Bipolar Trials Network. The 10-site nationwide trial will evaluate the real-world advantages and disadvantages of quetiapine, a widely prescribed second-generation antipsychotic mood-stabilizing medication, compared to lithium, for treatment of the disorder. The study is funded by a $600,000 grant to Case Western Reserve University School of Medicine from the Agency for Healthcare Research Quality. The trial will began enrolling patients this week.
Bipolar disorder is a lifelong, chronic and highly recurrent, mood disorder characterized by episodes of mania or hypomania that alternate with episodes of major depression. Its course is often chronic and yields a high degree of human suffering which places the disorder among the top 10 causes of disability worldwide with associated costs of $70.6 billion per year for treatment and prevention.
"Studies that compare treatments for bipolar disorder usually don't allow participants to take other medications and most patients need several medications to feel and stay well, says Joseph R. Calabrese, MD, Professor of Psychiatry at CWRU School of Medicine, Director of the Mood Disorders Program at University Hospitals Case Medical Center and Principal Investigator of Bipolar CHOICE. "Bipolar CHOICE is unique because participants can be treated, not only with quetiapine or lithium, but with almost any other medication excluding other antipsychotics."
Over the past 10 years, the pharmacologic treatments for bipolar disorder have shifted away from lithium—which is available as a generic medication—in favor of newly developed antipsychotics, such as quetiapine. Both drugs have well documented side effects. Quetiapine has the risk of drowsiness, weight gain, and increases the risk of cardiovascular disease. Lithium is associated with the risk of long-term thyroid and kidney problems.
Dr. Calabrese believes that this study distinguishes itself as having the potential of making a real pragmatic contribution to the treatment of patients with bipolar disorder. He states that "Future trials need to focus on effectiveness, not just on whether one treatment appears better than placebo. We need studies that inform the day-to-day practice of psychiatry in a meaningful way. With real world studies in psychiatry viewed as being unusual, this study has the potential of doing just that."
The AHRQ grant is part of an investments made under the American Recovery and Reinvestment Act of 2009 which designated $1.1 billion to support patient-centered outcomes research. This research is designed to inform health care decisions by providing evidence and information on the effectiveness, benefits and harms of different treatment options. Ten grants totaling $100 million were awarded across the country and this particular one was the only one awarded to study mental illness.
More information about the Mood Disorders Program may be found at www.case.edu/mdp.