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Mifepristone, a progesterone antagonist at low doses and a glucocorticoid receptor antagonist that can attenuate hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis at higher doses, has produced inconsistent results as a treatment for psychotic depression (JW Psychiatry Nov 21 2002). Because cognitive dysfunction in bipolar depression may be associated with HPA hyperactivity, researchers in the U.K. examined the effect of adjunctive mifepristone on cognition in 60 patients with bipolar depression. Two authors have patent interests in a related treatment.
Patients were randomized to receive mifepristone (600 mg/day) or placebo for 1 week, added to stable existing medications. At baseline, all patients demonstrated global neuropsych…