Copyright © 2005 Elsevier Ltd All rights reserved.
Adjunctive herbal medicine with carbamazepine for bipolar disorders: A double-blind, randomized, placebo-controlled study
Received 11 March 2005;
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Abstract
Chinese herbal medicines possess the therapeutic potential for mood disorders. This double-blind, randomized, placebo-controlled study was designed to evaluate the efficacy and side effects of the herbal medicine called Free and Easy Wanderer Plus (FEWP) as an adjunct to carbamazepine (CBZ) in patients with bipolar disorders. One hundred and twenty-four bipolar depressed and 111 manic patients were randomized to treatment with CBZ alone, CBZ plus FEWP, or equivalent placebo for 12 weeks. CBZ was initiated at 300 mg/day and FEWP was given at a fixed dose of 36 g/day. Efficacy measures included the Hamilton Rating Scale for Depression, Montgomery-Asberg Depression Rating Scale , Young Mania Rating Scale, Bech-Rafaelsen Mania Scale, and Clinical Global Impression-Severity (CGI-S). CBZ monotherapy produced significantly greater improvement on manic measures at week 2 through endpoint and CGI-S of depression at endpoint compared to placebo. CBZ monotherapy also yielded significantly higher clinical response rates than placebo on bipolar depression (63.8% vs. 34.8%, p = 0.044) and mania (87.8% vs. 57.1%, p = 0.012). Compared to CBZ monotherapy, adjunctive FEWP with CBZ resulted in significantly better outcomes on the three measures of depression at week 4 and week 8 and significantly greater clinical response rate in depressed subjects (84.8% vs. 63.8%, p = 0.032), but failed to produce significantly greater improvement on manic measures and the response rate in manic subjects. There was a lesser incidence of dizziness and fatigue in the combination therapy compared to CBZ monotherapy. These results suggest that adjunctive FEWP has additive beneficial effects in bipolar patients, particularly for those in depressive phase.
Keywords: Herbal medicine; Carbamazepine; Bipolar disorders; Bipolar depression; Mania; Clinical trial
Article Outline
- 1. Introduction
- 2. Materials and methods
- 2.1. Subjects
- 2.2. Preparation of CBZ and placebo
- 2.3. Preparation of herbal medicine and placebo
- 2.4. Study procedures
- 2.5. Assessments
- 2.6. Consistency of ratings and blinding
- 2.7. Data analyses
- 3. Results
- 3.1. Patient characteristics
- 3.2. Efficacy in patients with bipolar depression
- 3.3. Efficacy in patients with mania
- 3.4. Adverse events
- 4. Discussion
- Acknowledgements
- References







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0.050 vs. placebo. (b) p
50% reduction in score on HAMD for depression and YMRS for mania from baseline to endpoint based on LOCF (A, C) and OC (B, D) data analyses. Responders are indicated as black column and non-responders as white column. *p < 0.05 vs. PBO; # p < 0.05 vs. CBZ alone, with Fisher Exact test.