Possibility of a New Indication for Amantadine in the Treatment of Bipolar Depression—Case Series Study
Abstract
:1. Introduction
2. Results
- A 51-year-old Caucasian male diagnosed with bipolar disorder since 2002, when he had his first episode of mania. Since then, the patient was treated with valproic acid in the dose of 1500 mg and lithium carbonate in the dose of 750 mg daily (serum concentration of 0.6 mmol/L). In 2016, he had a moderate episode of depression (16 points on HDRS). The clinical picture was dominated by anhedonia, apathy, lack of energy and motivation, anxiety, and indifference. Further attempts were made to treat depression with quetiapine 300 mg/day, olanzapine 10 mg together with fluoxetine 20 mg daily, and antidepressants: sertraline up to 200 mg daily and escitalopram up to 20 mg daily. However, despite treatment, each time for at least 6 weeks, none of these interventions resulted in improvement. The patient was then offered to add amantadine to lithium carbonate and valproic acid in an initial dose of 100 mg in the morning. After one week, the patient reported a slight improvement (15 points on the HDRS scale). With the patient’s consent, the dose was increased to 200 mg amantadine in the morning. After another week, the severity of depression in HDRS was 8 points. From the patient’s report, the improvement occurred 3–4 days after increasing the dose of amantadine. After another week, HDRS was 2 points (Figure 2). The patient continued treatment with amantadine for another 2 weeks, then reduced the dose to 100 mg in the morning and stopped the drug after three days. During the treatment, no side effects of amantadine were observed, no change in the manic phase, and no recurrence of depressive symptoms after drug discontinuation.
- A 56-year-old Caucasian male treated for bipolar disorder since 2016, when he experienced a two-month manic episode. He then received valproic acid in a dose of 1500 mg daily and olanzapine in a dose of 20 mg in the evening. His mania symptoms resolved and he was then treated only with valproic acid. In 2017, he reported significant depression (19 points on the HDRS scale). The clinical picture was dominated by tearfulness, sadness, lack of motivation, anhedonia, lack of energy, and difficulty with concentration. He received lamotrigine at the target dose of 150 mg/day, but after 4 months the depression was still there (15 points on the HDRS scale). He then received mirtazapine in a dose of 30 mg in the evening, but after another 2 months, the symptoms remained (16 points on the HDRS scale). The patient was then offered to add amantadine at an initial dose of 100 mg in the morning to valproic acid and lamotrigine. As there was no improvement after one week, the amantadine dose was increased to 200 mg in the morning. After another week, the patient felt better (HDRS 9 points). At the visit after 3 weeks of treatment with amantadine, the patient had an HDRS score of 4 (Figure 2). He continued treatment for another 2 weeks, then lowered the dose to 100 mg in the morning, and stopped taking the drug after 3 days. There were no adverse effects of amantadine and no change from the depressive phase to the manic one, and no relapse of depression after discontinuation of amantadine.
- A 50-year-old Caucasian man has had bipolar disorder since the age of 31. He started psychiatric treatment in 2013, when the manic episode was followed by an episode of depression that lasted 5 months (12 points on the HDRS scale at the first visit). The patient then received quetiapine, but was unable to function professionally due to sedation at a dose of 100 mg. The treatment was changed to lithium carbonate at a dose of 500 mg per day (serum concentration of 0.6 mmol/L). The patient felt better (6 points on the HDRS scale), but in 2014 there was another episode of depression (14 points on the HDRS scale). The patient then did not respond to 20 mg escitalopram for 6 weeks and then to 150 mg bupropion in the morning for 2 months. He was then offered to add amantadine to the lithium carbonate in an initial dose of 100 mg in the morning. The patient reported a slight improvement at the visit after one week of treatment (12 points on the HDRS scale). Due to incomplete improvement, the dose was increased to 200 mg amantadine in the morning. According to the patient, the improvement was achieved within 2 days (6 points on the HDRS scale after 2 weeks of treatment). After 3 weeks, the HDRS was 5 points (Figure 2). After another 2 weeks, the patient stopped taking amantadine within 3 days. There were no adverse effects of amantadine, no manic switch, and no recurrence of depression after discontinuation of amantadine.
- A 45-year-old Caucasian woman was diagnosed with BD-I in 2015. She had previously had a four-month manic episode, followed by a depressive episode for three months. She then received quetiapine at a target dose of 300 mg in the evening. The patient tolerated the drug well, but her mood improved only after 6 months of treatment. In 2017, there was another episode of depression (15 points on the HDRS scale), after an earlier short episode of hypomania. She received 30 mg of mirtazapine in the evening, but after 6 weeks there was no improvement and the patient gained 3 kg body weight. She was switched to 150 mg bupropion in the morning, but after another 2 months, there was still no improvement. The patient was then offered to add amantadine 100 mg in the morning to 300 mg of quetiapine. Improvement was observed after 7 days of taking amantadine (HDRS 8 points). After 2 weeks, HDRS was 5 points, and after 3 weeks, 1 point (Figure 2). The patient took 100 mg of amantadine for 2 weeks and then gradually, within 3 days, stopped taking it. As before, no adverse effects of amantadine, no change from the depressive phase to the manic phase, and no recurrence of depressive symptoms after discontinuation of amantadine were observed.
3. Discussion
4. Materials and Methods
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Patients | 1-st Week | 2-nd Week | 3-rd Week |
---|---|---|---|
case | daily dose (improvement from baseline) | ||
1 (male) | 100 mg (6%) | 200 mg (50%) | 200 mg (87.5%) |
2 (male) | 100 mg (0%) | 200 mg (44%) | 200 mg (75%) |
3 (male) | 100 mg (14%) | 200 mg (57%) | 200 mg (64%) |
4 (female) | 100 mg (66%) | 100 mg (66%) | 100 mg (93%) |
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Krzystanek, M.; Pałasz, A. Possibility of a New Indication for Amantadine in the Treatment of Bipolar Depression—Case Series Study. Pharmaceuticals 2020, 13, 326. https://doi.org/10.3390/ph13100326
Krzystanek M, Pałasz A. Possibility of a New Indication for Amantadine in the Treatment of Bipolar Depression—Case Series Study. Pharmaceuticals. 2020; 13(10):326. https://doi.org/10.3390/ph13100326
Chicago/Turabian StyleKrzystanek, Marek, and Artur Pałasz. 2020. "Possibility of a New Indication for Amantadine in the Treatment of Bipolar Depression—Case Series Study" Pharmaceuticals 13, no. 10: 326. https://doi.org/10.3390/ph13100326
APA StyleKrzystanek, M., & Pałasz, A. (2020). Possibility of a New Indication for Amantadine in the Treatment of Bipolar Depression—Case Series Study. Pharmaceuticals, 13(10), 326. https://doi.org/10.3390/ph13100326