Q: Requests Info on Saphris and Insight on ECT
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
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…
Published May, 2010