Do you have any information about riluzole (Rilutek)?  My doctor is not  familiar with it and the only info I can find on line are research studies.  Does it seem effective- especially with depression?


Dear Barbara --
Frankly, I know only that it has been used to treat bipolar depression. I have never used it myself. Generally I wait as long as possible before using a brand-new medication like this one. Let someone else find out what the serious problems are, if they are going to emerge. At this point, the only reason for even considering use of riluzole would be having exhausted all of the more routine medication approaches -- or bipolar depression in someone with ALS (amyotrophic lateral sclerosis, sometimes called Lou Gehrig's disease, the condition for which riluzole currently has an indication).

Okay, having gotten that "purist" blather off my chest, what is known about riluzole in bipolar disorder? Let us use your question as an occasion for a look.

Searching Pub Med for riluzole bipolar yields one case report, and one open trial that included 14 patients.^Zarate  Remember that an open trial means no placebo group and no "blind": everybody knows, both patient and researcher, that the patient is on a new medication. Good results at this stage are only suggestive. Often when the next stage is reached, a "randomized trial", with a placebo group, the results are far less impressive. 

By comparison, we have better data for the dopamine agonists pramipexole and ropinirole, both of which have small randomized trials demonstrating their efficacy in bipolar depression. Both of these agents are very new to the scene, and they are seeing very limited use so far.  Because these have randomized trials demonstrating their effectiveness, I've tried each of them a few times. Unfortunately, the side effects were quite overwhelming when the dose was pushed out, and the low doses that are better tolerated to not do much -- although these were very treatment resistant patients (you expect them to be: only such patients would warrant trying medications with as little road testing as these).

I hope that addresses your question to some extent.

Dr. Phelps



Published January, 2008