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Improved stress response in bipolar affective disorder with adjunctive spironolactone (mineralocorticoid receptor antagonist): case series

Section of Neurobiology of Mood Disorders and Stress, Psychiatry and Immunology Lab, Institute of Psychiatry, King's College/University of London, UK

CS Gama

Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, Porto Alegre, RS, Brazil, csgama{at}yahoo.com, Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong, Victoria, Australia

M. Berk

Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong, Victoria Australia

PS Belmonte-de-Abreu

Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, Porto Alegre, RS, Brazil

The psychopathologies underlying affective disorders are thought to involve persistent changes in the expression and function of both mineralocorticoid receptors and glucocorticoid receptors in the hippocampus. In addition, exposure to stressful stimuli can precipitate episodes in vulnerable individuals. The aim of this study is to determine if spironolactone as an adjunctive therapy is effective in improving residual symptoms in bipolar disorder. Four cases of euthymic bipolar disorder (BD) patients were treated with spironolactone as an adjunctive therapy in a private treatment sector. All patients met the DSM-IV diagnosis criteria for bipolar disorder. Clinical response was assessed retrospectively using the Clinical Global Impression Scale for Improvement. Spironolactone was effective in all patients. The four cases illustrate a clinical response to residual symptoms and improvement in stress response after use of spironolactone as an adjunctive therapy in BD. This pilot case series suggests reducing in residual symptoms, with spironolactone as an adjunctive therapy in these DSM-IV BD patients. Mineralocorticoid receptors antagonists’ role in reducing stress-induced symptoms deserves further investigation through placebo-controlled trials.

Key Words: bipolar disorder • HPA axis • mineralocorticoid antagonist • serotonin • residual symptoms

This version was published on November 1, 2009

Journal of Psychopharmacology, Vol. 23, No. 8, 985-987 (2009)
DOI: 10.1177/0269881108092121


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