Methylene blue treatment for residual symptoms of bipolar disorder: randomised crossover study

Background Residual symptoms and cognitive impairment are among important sources of disability in patients with bipolar disorder. Methylene blue could improve such symptoms because of its potential neuroprotective effects. Aims We conducted a double-blind crossover study of a low dose (15 mg, 'placebo') and an active dose (195 mg) of methylene blue in patients with bipolar disorder treated with lamotrigine. Method Thirty-seven participants were enrolled in a 6-month trial (trial registration: NCT00214877). The outcome measures included severity of depression, mania and anxiety, and cognitive functioning. Results The active dose of methylene blue significantly improved symptoms of depression both on the Montgomery-Asberg Depression Rating Scale and Hamilton Rating Scale for Depression (P=0.02 and 0.05 in last-observation-carried forward analysis). It also reduced the symptoms of anxiety measured by the Hamilton Rating Scale for Anxiety (P=0.02). The symptoms of mania remained low and stable throughout the study. The effects of methylene blue on cognitive symptoms were not significant. The medication was well tolerated with transient and mild side-effects. Conclusions Methylene blue used as an adjunctive medication improved residual symptoms of depression and anxiety in patients with bipolar disorder. (C) The Royal College of Psychiatrists 2017.