Requests Info on Saphris and Insight on ECT
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Q:  Requests Info on Saphris and Insight on ECT

Dr. Phelps: 

You've been very helpful in answering a couple of my questions in the past and I now have another one - two actually.  I'm a depressive bipolar II, very treatment resistant when it comes to the depression with fairly mild, brief hypomanic episodes. (along with ADD and a little anxiety thrown in on the side)  I spend the rest of my time at some level of depression. My psychiatrist and I have tried everything that I can feasibly take - all kinds of combinations, etc., including the newer atypical antipsychotics Abilify and Geodon over a span of about 12-13 years. 

He just started me on one called Saphris as a last shot before ECT, and it seems to be working, or at least finally and quickly lifting some of the extreme depression I've been experiencing for over a year now.  What do you know about Saphris?  I realize it is brand new and meant for schizophrenia and bipolar mania, not depression, but somehow it's  working for my bipolar depression in combination with all of my other meds. 

Also, what are your thoughts on ECT?  I've tried to put it off as an absolute last resort because of the possible memory problems it can cause, but this episode of depression has lasted so much longer and been much, much worse than any I've had in over 10 years, even to the point of being suicidal for a short period of time.  I  would just like to live depression-free, though I don't know if I'd recognize it if I got there.   

Any information on Saphris and insight on ECT you can provide would be much appreciated.  Thanks again!


Dear L’ --
Glad to hear that this new kid on the block may have some value for symptoms like yours (as I’ve got plenty of folks with similar stories, so if this result sticks, that will be great for you and great for a lot of other people too).  

As you’ve learned, asenapine (Saphris) is intended for bipolar I mania, according to what the manufacturer can claim (which is limited diagnoses for which the FDA has awarded an “indication” ). But as soon as it hit the market, psychiatrists and other physicians are at liberty to use it for other diagnoses, e.g. Bipolar II. This is so-called “off-label” prescribing.  

As time goes on we gradually accumulate experience with a new medication, both for its original indication diagnosis and for off-label purposes. So far, not much buzz, it’s pretty new. Frankly, your experience is one of the first I’m chalking up on the plus side. No big bad news on the negative side yet, that I’ve heard, that’s more than just rumor. It was not quite as good as olanzapine (Zyprexa) in a head-to-head trial (which I’ve not read, it just came out) but didn’t cause as much weight gain as olanzapine, which is good news. It did cause more weight gain than placebo though, which is bad news as we could certainly use a powerful tool that doesn’t cause weight gain. Frye et al, J Affect Disorders 2010 April 

ECT (electroconvulsive therapy) is certainly worth considering; it can definitely work in treatment-resistant depression. The new techniques make each administration of ECT, each time you have it, rather a non-event: anesthesia is brief but should completely prevent any memory of the treatment that day, and also prevent the muscle aches and other things which used to be part of this experience until anesthesia was routinely used. The new techniques are also reducing the memory impairment for events prior to ECT, which has been the biggest side effect problem with this approach.  

If it works (which I hope it does for you, should you get there; odds are pretty good, even with your history), the question then becomes “what now?” How do you prevent a return of depression? For that we have far fewer research data. You and your psychiatrist will discuss options, which include “maintenance ECT”. That means using a session of ECT once  a month or so (the initial treatment is usually 2 or 3 sessions per week) to stay well.  

Good luck with asenapine or your next steps after that… 

Dr. Phelps

Published May, 2010



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