Pregnenolone Effective for Bipolar Depression

the Psychiatry Advisor take:

Depression is common in bipolar disorder, and unfortunately, often proves difficult for mental health professionals to treat properly. As a result, additional drugs are normally added to treatment regimens.

Mood stabilizers, such as lithium and the anticonvulsants lamotrigine (Lamictal) and valproate (Depakote) are commonly used to treat bipolar depression, often in combination with antidepressants.

Now researchers at the University of Texas Southwestern Medical Center in Dallas have examined the efficacy of the neurosteroid pregnenolone to treat depression in this population.

E. Sherwood Brown, MD, PhD, Chief of the Division of Bipolar Disorders at the hospital, and colleagues analyzed data from 80 adults with bipolar disorder and depression, and randomly assigned patients to receive pregnenolone or placebo as add-on therapy for 12 weeks.

Outcomes were measured using the Hamilton Rating Scale for Depression (HRSD), Inventory of Depressive Symptomatology—Self-Report (IDS-SR), Hamilton Rating Scale for Anxiety (HRSA), and Young Mania Rating Scale. Blood neurosteroid levels were monitored throughout the study.

“Depression remission rates were greater in the pregnenolone group (61%) compared with the placebo group (37%), as assessed by the IDS-SR (χ2(1)=3.99, P=0.046), but not the HRSD,” the researchers reported Neuropsychopharmacology.

Large changes in neurosteroid levels from baseline to the study exit period were observed in the pregnenolone group, but not in the placebo group -- suggesting high treatment adherence.

Overall, pregnenolone was well tolerated and the authors concluded  the drug may reduce depression in bipolar patients with depression.

Neurosteroid Studied as Bipolar Depression Treatment
Neurosteroid Studied as Bipolar Depression Treatment

Depression in bipolar disorder (BPD) is challenging to treat. Therefore, additional medication options are needed. In a recent study, the effect of the neurosteroid pregnenolone on depressive symptoms in BPD was examined.

Adults (n=80) with BPD, depressed mood state, were randomized to pregnenolone (titrated to 500 mg/day) or placebo, as add-on therapy, for 12 weeks. Outcome measures included the 17-item Hamilton Rating Scale for Depression (HRSD), Inventory of Depressive Symptomatology—Self-Report (IDS-SR), Hamilton Rating Scale for Anxiety (HRSA), and Young Mania Rating Scale (YMRS).

The results suggest that pregnenolone may improve depressive symptoms in patients with BPD and can be safely administered.

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