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  1. Article: Antidepressants and antipsychotics in the long-term treatment of bipolar disorder.

    Kusumakar, Vivek

    The Journal of clinical psychiatry

    2002  Volume 63 Suppl 10, Page(s) 23–28

    Abstract: Antidepressants and antipsychotics are frequently used as mood stabilizers in the treatment of bipolar disorder. As common as these agents appear to be in bipolar treatment, the literature contains little research on their efficacy and safety in the long ...

    Abstract Antidepressants and antipsychotics are frequently used as mood stabilizers in the treatment of bipolar disorder. As common as these agents appear to be in bipolar treatment, the literature contains little research on their efficacy and safety in the long term. Most of the available literature on long-term antidepressant treatment focuses on tricyclic antidepressants, which have been shown to induce mania or hypomania. Rapid cycling is another side effect that is associated with antidepressant treatment in bipolar disorder. Antidepressants do not appear to be any more effective than mood stabilizers in treating bipolar depression. Conventional antipsychotics in depot formulations have been shown to be an effective treatment, but conventional antipsychotics may cause tardive dyskinesia. The novel antipsychotics clozapine, risperidone, and olanzapine appear to be efficacious; however, their side effect profiles include agranulocytosis and weight gain. Given the frequency with which antidepressants and antipsychotics are used in bipolar disorder and that bipolar disorder is a chronic disease requiring maintenance treatment, more research on the use of these types of agents in long-term treatment is needed. Until more evidence is available on the long-term treatment outcomes, clinicians should be aware that the adverse events associated with antidepressants and antipsychotics may outweigh the benefit, if any, of the use of these agents in bipolar disorder.
    MeSH term(s) Agranulocytosis/chemically induced ; Antidepressive Agents/adverse effects ; Antidepressive Agents/therapeutic use ; Antipsychotic Agents/adverse effects ; Antipsychotic Agents/therapeutic use ; Bipolar Disorder/chemically induced ; Bipolar Disorder/drug therapy ; Bipolar Disorder/prevention & control ; Bipolar Disorder/psychology ; Clinical Trials as Topic ; Clozapine/adverse effects ; Clozapine/therapeutic use ; Delayed-Action Preparations ; Double-Blind Method ; Drug Administration Schedule ; Drug Therapy, Combination ; Humans ; Long-Term Care ; Treatment Outcome ; Weight Gain
    Chemical Substances Antidepressive Agents ; Antipsychotic Agents ; Delayed-Action Preparations ; Clozapine (J60AR2IKIC)
    Language English
    Publishing date 2002
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 716287-x
    ISSN 1555-2101 ; 0160-6689
    ISSN (online) 1555-2101
    ISSN 0160-6689
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  2. Article: Open trial of interpersonal therapy in adolescents with moderate to severe major depression: effectiveness of novice IPT therapists.

    Santor, D A / Kusumakar, V

    Journal of the American Academy of Child and Adolescent Psychiatry

    2001  Volume 40, Issue 2, Page(s) 236–240

    Abstract: Objective: To evaluate the effectiveness of interpersonal therapy (IPT) implemented by well-supervised, novice IPT therapists in treating adolescents with moderate to severe mood disorders of lengthy duration.: Method: Twenty-five adolescents with ... ...

    Abstract Objective: To evaluate the effectiveness of interpersonal therapy (IPT) implemented by well-supervised, novice IPT therapists in treating adolescents with moderate to severe mood disorders of lengthy duration.
    Method: Twenty-five adolescents with moderate to severe major depression, lasting an average of 8 months, received 12 weeks of IPT. All participants were assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), and the Children's Global Assessment Scale (C-GAS) at baseline and follow-up.
    Results: The majority of participants improved substantially on the BDI, the HRSD, and the C-GAS; 84% met remission criteria on the HRSD (score < 7); and 80% met remission criteria on the BDI (score < 10).
    Conclusions: Results demonstrate that IPT is effective in treating moderately to severely depressed adolescents, that IPT is effective with depression lasting several months, and that IPT can be effectively implemented by well-supervised clinicians with no prior training in IPT.
    MeSH term(s) Adolescent ; Depressive Disorder/therapy ; Female ; Humans ; Male ; Nova Scotia ; Psychotherapy, Brief/education ; Psychotherapy, Brief/methods ; Severity of Illness Index ; Treatment Outcome
    Language English
    Publishing date 2001-02
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 392535-3
    ISSN 1527-5418 ; 0890-8567
    ISSN (online) 1527-5418
    ISSN 0890-8567
    DOI 10.1097/00004583-200102000-00019
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  3. Article: Lamotrigine treatment of rapid cycling bipolar disorder.

    Kusumakar, V / Yatham, L N

    The American journal of psychiatry

    1997  Volume 154, Issue 8, Page(s) 1171–1172

    MeSH term(s) Adult ; Aged ; Anticonvulsants/therapeutic use ; Bipolar Disorder/drug therapy ; Drug Administration Schedule ; Drug Eruptions/etiology ; Drug Therapy, Combination ; Humans ; Lamotrigine ; Triazines/therapeutic use ; Valproic Acid/therapeutic use
    Chemical Substances Anticonvulsants ; Triazines ; Valproic Acid (614OI1Z5WI) ; Lamotrigine (U3H27498KS)
    Language English
    Publishing date 1997-07-01
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 280045-7
    ISSN 1535-7228 ; 0002-953X
    ISSN (online) 1535-7228
    ISSN 0002-953X
    DOI 10.1176/ajp.154.8.1171b
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  4. Article: An open study of lamotrigine in refractory bipolar depression.

    Kusumakar, V / Yatham, L N

    Psychiatry research

    1997  Volume 72, Issue 2, Page(s) 145–148

    Abstract: Bipolar depressed patients (n = 22) who were refractory to treatment with a combination of divalproex sodium (DVP) and another mood stabilizer or DVP and an antidepressant for 6 weeks were treated in an open naturalistic study with an addition of ... ...

    Abstract Bipolar depressed patients (n = 22) who were refractory to treatment with a combination of divalproex sodium (DVP) and another mood stabilizer or DVP and an antidepressant for 6 weeks were treated in an open naturalistic study with an addition of lamotrigine to DVP. Sixteen out of 22 (72%) responded by the end of week 4 and none developed rash or switched to mania. The results of this preliminary study suggest that lamotrigine may be useful in bipolar depression.
    MeSH term(s) Adolescent ; Adult ; Anticonvulsants/administration & dosage ; Anticonvulsants/adverse effects ; Antidepressive Agents/administration & dosage ; Antidepressive Agents/adverse effects ; Bipolar Disorder/drug therapy ; Bipolar Disorder/psychology ; Cohort Studies ; Depressive Disorder/drug therapy ; Depressive Disorder/psychology ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Humans ; Lamotrigine ; Male ; Personality Inventory ; Psychiatric Status Rating Scales ; Treatment Outcome ; Triazines/administration & dosage ; Triazines/adverse effects ; Valproic Acid/administration & dosage ; Valproic Acid/adverse effects
    Chemical Substances Anticonvulsants ; Antidepressive Agents ; Triazines ; Valproic Acid (614OI1Z5WI) ; Lamotrigine (U3H27498KS)
    Language English
    Publishing date 1997-09-19
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 445361-x
    ISSN 1872-7123 ; 1872-7506 ; 0165-1781 ; 0925-4927
    ISSN (online) 1872-7123 ; 1872-7506
    ISSN 0165-1781 ; 0925-4927
    DOI 10.1016/s0165-1781(97)00082-6
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  5. Article: Choline in pediatric depression.

    MacMaster, Frank P / Kusumakar, Vivek

    McGill journal of medicine : MJM : an international forum for the advancement of medical sciences by students

    2009  Volume 9, Issue 1, Page(s) 24–27

    Abstract: Purpose of study: The prefrontal cortex has been previously implicated in the neuropathology of major depressive disorder (MDD). Hence, we used proton magnetic resonance spectroscopy (1H-MRS) to examine choline levels in the prefrontal cortex of youth ... ...

    Abstract Purpose of study: The prefrontal cortex has been previously implicated in the neuropathology of major depressive disorder (MDD). Hence, we used proton magnetic resonance spectroscopy (1H-MRS) to examine choline levels in the prefrontal cortex of youth with major depression.
    Basic procedures: Twelve age- and sex-matched case-control pairs were examined (age range 10 to 18 years, 7 females and 5 males in each group). All subjects were treatment naive at the time of the scan. A long echo 1H-MRS scan was acquired from the right prefrontal cortex (4cc) in all subjects.
    Main findings: Right prefrontal Choline/Creatine ratios were elevated in the youth with mood disorders (F1, 11=10.741, p=0.007) as compared with healthy controls.
    Principal conclusions: These findings suggest that prefrontal cytosolic choline may be increased in youth with MDD in comparison with healthy controls. This is consistent with reported findings in both adults and adolescents and suggests that MDD in youth is associated with alterations in choline metabolism in the prefrontal cortex.
    Language English
    Publishing date 2009-06-04
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 1433496-3
    ISSN 1715-8125 ; 1201-026X
    ISSN (online) 1715-8125
    ISSN 1201-026X
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  6. Article: A pilot study of loading versus titration of valproate in the treatment of acute mania.

    Oluboka, O J / Bird, D C / Kutcher, S / Kusumakar, V

    Bipolar disorders

    2002  Volume 4, Issue 5, Page(s) 341–345

    Abstract: Objective: This double-blind pilot study compares the effectiveness and incidence of adverse effects of oral loading versus titration schedules of valproate in acute mania.: Method: Consecutive new admissions for an acute manic episode were ... ...

    Abstract Objective: This double-blind pilot study compares the effectiveness and incidence of adverse effects of oral loading versus titration schedules of valproate in acute mania.
    Method: Consecutive new admissions for an acute manic episode were prescribed either an oral loading dose (20 mg/kg/day; n = 5; mean age = 33.4) or slower titration dose (10 mg/kg/day, n = 6. mean age = 30.6) of valproate for 7 days without other psychotropic agents. with the exception of benzodiazepines. Daily outcome measures included: serum valproic acid levels, the Young Mania Rating Scale (YMRS), the Brief Psychiatry Rating Scale (BPRS), the Clinical Global Impression Scale (CGI) and the Adverse Effect Rating Scale.
    Results: The mean serum valproic acid levels were significantly higher in the loading group when compared with the titration group after 1 and 2 days following the initiation of treatment (p < 0.05). After 3 days of treatment there was a trend for the group that received the loading regimen to have slightly more improvement in YMRS scores compared with the titration group. Side-effects were minor for both treatments, however, a higher incidence of side-effects was reported in the titration group, with 50% of patients reporting sedation most likely because of increased use of benzodiazepines.
    Conclusion: This suggests that a loading dose of valproate is likely safe and may provide an earlier onset of antimanic effects in patients with bipolar disorder. Future studies with larger sample sizes are indicated.
    MeSH term(s) Acute Disease ; Adolescent ; Adult ; Aged ; Antidepressive Agents/administration & dosage ; Antidepressive Agents/therapeutic use ; Bipolar Disorder/diagnosis ; Bipolar Disorder/drug therapy ; Diagnostic and Statistical Manual of Mental Disorders ; Double-Blind Method ; Drug Administration Schedule ; Female ; Humans ; Male ; Middle Aged ; Pilot Projects ; Valproic Acid/administration & dosage ; Valproic Acid/therapeutic use
    Chemical Substances Antidepressive Agents ; Valproic Acid (614OI1Z5WI)
    Language English
    Publishing date 2002-12-10
    Publishing country Denmark
    Document type Clinical Trial ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 1472242-2
    ISSN 1399-5618 ; 1398-5647
    ISSN (online) 1399-5618
    ISSN 1398-5647
    DOI 10.1034/j.1399-5618.2002.01224.x
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  7. Article: Assessment of noradrenergic functioning in patients with non-combat-related posttraumatic stress disorder: a study with desmethylimipramine and orthostatic challenges.

    Yatham, L N / Sacamano, J / Kusumakar, V

    Psychiatry research

    1996  Volume 63, Issue 1, Page(s) 1–6

    Abstract: The functioning of the noradrenergic system was assessed in 16 patients with non-combat-related posttraumatic stress disorder (PTSD) and the same number of age- and sex-matched healthy subjects by measuring (1) plasma norepinephrine (NE) levels in supine ...

    Abstract The functioning of the noradrenergic system was assessed in 16 patients with non-combat-related posttraumatic stress disorder (PTSD) and the same number of age- and sex-matched healthy subjects by measuring (1) plasma norepinephrine (NE) levels in supine and upright postures, and (2) growth hormone (GH) responses to challenge with desmethylimipramine (DMI), a NE reuptake inhibitor. Subjects were cannulated at 08:30 h after an overnight fast. Blood samples were drawn for NE levels with subjects in a supine position and after 5 min of standing. After subjects were allowed to rest for 30 min in a supine position, a blood sample was drawn for basal GH (T-15) levels. The second baseline sample was drawn 15 min later (T0), at which time DMI (1 mg/kg) was given orally, and further blood samples were drawn at 90, 120, and 180 min. PTSD patients had significantly higher baseline NE levels and blunted NE responsivity to postural challenge compared with normal subjects. Basal and DMI-induced GH levels, on the other hand, did not differ in PTSD versus normal subjects. Overall, these findings suggest that non-combat-related PTSD patients have peripheral noradrenergic dysregulation, but central postsynaptic alpha 2-adrenergic receptor sensitivity is not altered in this patient population.
    MeSH term(s) Adolescent ; Adrenergic Uptake Inhibitors ; Adult ; Arousal/physiology ; Desipramine ; Female ; Human Growth Hormone/blood ; Humans ; Male ; Middle Aged ; Norepinephrine/physiology ; Posture/physiology ; Receptors, Adrenergic, alpha-2/physiology ; Stress Disorders, Post-Traumatic/diagnosis ; Stress Disorders, Post-Traumatic/physiopathology ; Stress Disorders, Post-Traumatic/psychology
    Chemical Substances Adrenergic Uptake Inhibitors ; Receptors, Adrenergic, alpha-2 ; Human Growth Hormone (12629-01-5) ; Desipramine (TG537D343B) ; Norepinephrine (X4W3ENH1CV)
    Language English
    Publishing date 1996-06-26
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 445361-x
    ISSN 1872-7123 ; 1872-7506 ; 0165-1781 ; 0925-4927
    ISSN (online) 1872-7123 ; 1872-7506
    ISSN 0165-1781 ; 0925-4927
    DOI 10.1016/0165-1781(96)02896-x
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  8. Article: The characteristics of asymptomatic female adolescents at high risk for depression: the baseline assessment from a prospective 8-year study.

    Kutcher, S / Kusumakar, V / LeBlanc, J / Santor, D / Lagace, D / Morehouse, R

    Journal of affective disorders

    2004  Volume 79, Issue 1-3, Page(s) 177–185

    Abstract: Objectives: This longitudinal 8-year study assesses potential predictors of major depressive disorder (MDD) in a cohort of healthy adolescent females at high familial risk for MDD. The objective of this study was to ascertain whether risk factors for ... ...

    Abstract Objectives: This longitudinal 8-year study assesses potential predictors of major depressive disorder (MDD) in a cohort of healthy adolescent females at high familial risk for MDD. The objective of this study was to ascertain whether risk factors for female onset MDD would differentiate youth at high or usual risk for MDD, prior to the onset of depressive symptomology.
    Methods: Subjects (ages 12-15 years) were assigned to a high (n=43) or usual (n=40) risk group according to maternal history of MDD. Depressive symptomatology (Beck Depression Inventory, Hamilton Rating Scale for Depression), pubertal development (Pubertal Developmental Staging Questionnaire), social support (Social Support Scale), and cognitive vulnerability (Depressive Experiences Questionnaire) were assessed.
    Results: High risk and usual risk group demonstrated no significant differences in demographic variables such as age, body mass index, and grade. Significantly more youth in the high risk group (n=40, 93%) had started menstruation, compared to youth in the usual risk group (n=31, 77.5%). There were no significant differences between the groups on measures of dysphoric cognitive style, perceived overall number of social supports, or satisfaction with social support.
    Conclusions: Females at high familial risk for the onset of depression have significant differences in pubertal development, but not in demographics, depressive symptoms, social supports, or dysphoric cognitive style, when compared to females at usual risk for depression. These findings suggest that in prevention trials for depression in asymptomatic young women no non-biological risk factors for MDD aid in identifying females at higher risk for MDD.
    MeSH term(s) Adolescent ; Adolescent Behavior ; Age Factors ; Body Mass Index ; Child ; Depressive Disorder/etiology ; Depressive Disorder/genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Longitudinal Studies ; Menarche ; Pedigree ; Prospective Studies ; Psychiatric Status Rating Scales ; Reference Values ; Risk Factors ; Social Support
    Language English
    Publishing date 2004-04
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 135449-8
    ISSN 1573-2517 ; 0165-0327
    ISSN (online) 1573-2517
    ISSN 0165-0327
    DOI 10.1016/S0165-0327(02)00458-5
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  9. Article: Pituitary gland volume in adolescent and young adult bipolar and unipolar depression.

    MacMaster, Frank P / Leslie, Ronald / Rosenberg, David R / Kusumakar, Vivek

    Bipolar disorders

    2008  Volume 10, Issue 1, Page(s) 101–104

    Abstract: Objectives: Few studies have examined pituitary gland size in mood disorders, particularly in adolescents. We hypothesized increase in the pituitary gland size in early-onset mood disorders.: Methods: Thirty subjects between the ages of 13 and 20 ... ...

    Abstract Objectives: Few studies have examined pituitary gland size in mood disorders, particularly in adolescents. We hypothesized increase in the pituitary gland size in early-onset mood disorders.
    Methods: Thirty subjects between the ages of 13 and 20 years participated in the study. Three groups (control, bipolar I depression and unipolar depression) of 10 subjects each (4 male, 6 female) underwent volumetric magnetic resonance imaging at 1.5 T.
    Results: Analysis of covariance (covarying for age, sex and intracranial volume) revealed a significant difference in pituitary gland volume amongst the groups [F(2,24) = 7.092, p = 0.014]. Post hoc analysis revealed that controls had a significantly smaller pituitary gland volume than both bipolar patients (p = 0.019) and depressed patients (p = 0.049). Bipolar and depressed subjects did not differ significantly from each other with regard to pituitary gland volume (p = 0.653). Control females had larger pituitary glands than control males [F(1,8) = 10.523, p = 0.012], but no sex differences were noted in the mood disorder groups.
    Conclusions: Pituitary glands are enlarged in adolescents with mood disorders compared to controls. Healthy young females have larger pituitary glands than males, but such a difference is not evident in individuals with unipolar depression or bipolar disorder. These findings provide new evidence of abnormalities of the pituitary in early onset mood disorders, and are consistent with neuroendocrine dysfunction in early stages of such illnesses.
    MeSH term(s) Adolescent ; Adult ; Age of Onset ; Analysis of Variance ; Bipolar Disorder/pathology ; Depressive Disorder/pathology ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Pituitary Gland/pathology ; Psychiatric Status Rating Scales
    Language English
    Publishing date 2008-02
    Publishing country Denmark
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1472242-2
    ISSN 1399-5618 ; 1398-5647
    ISSN (online) 1399-5618
    ISSN 1398-5647
    DOI 10.1111/j.1399-5618.2008.00476.x
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  10. Article: Psychosocial adjustment in children with port-wine stains and prominent ears.

    Sheerin, D / MacLeod, M / Kusumakar, V

    Journal of the American Academy of Child and Adolescent Psychiatry

    1995  Volume 34, Issue 12, Page(s) 1637–1647

    Abstract: Objective: To evaluate psychosocial adjustment in children with port-wine stain (PWS) and children with prominent ears (PE).: Method: Thirty-two children aged 7 to 16 years with facial PWS and 42 children with PE were evaluated using the Harter Self- ... ...

    Abstract Objective: To evaluate psychosocial adjustment in children with port-wine stain (PWS) and children with prominent ears (PE).
    Method: Thirty-two children aged 7 to 16 years with facial PWS and 42 children with PE were evaluated using the Harter Self-Perception Profile, the Revised Children's Manifest Anxiety Scale, the Children's Depression Inventory, the Disfigurement Perception Scale, and the Child Behavior Checklist. Results were compared with normative data for the local population or with a control group. Profile scores were correlated with severity of the PWS or prominence of the ears.
    Results: Children with PE had poorer self-perception, higher concentration anxiety, and more internalizing and externalizing symptoms, and they were more withdrawn and had more social problems than children with PWS. The children with PWS functioned as well as or better than nondisfigured peers on measurements of psychosocial adjustment, while children with PE scored lower than nondisfigured peers on measures of self-perception and parent-rated social and attention problems. There was no correlation between degree of disfigurement and level of psychosocial adjustment.
    Conclusions: Psychosocial adjustment varied according to the nature of the disfigurement or deformity and was unrelated to the severity of the disfigurement.
    MeSH term(s) Adaptation, Psychological ; Adolescent ; Child ; Ear, External/abnormalities ; Female ; Hemangioma/psychology ; Humans ; Internal-External Control ; Male ; Personality Development ; Self Concept ; Skin Neoplasms/psychology ; Social Adjustment
    Language English
    Publishing date 1995-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392535-3
    ISSN 1527-5418 ; 0890-8567
    ISSN (online) 1527-5418
    ISSN 0890-8567
    DOI 10.1097/00004583-199512000-00014
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