Expert: Ivan Goldberg, M.D. - 11/30/2010

Question
I have been battling long episodes of depression for 20 years.  I have been able to complete college and have a successful career in between episodes.  This current is taking a tole on me as they all have.  I completed Transcranial Magnetic Stimulation therapy which gave me some relief.  Is it possible that I may have Borna virus that comes and goes in remission due to stressors.  I am currently taking 10mg Abilify, 100 mg Trazadone, 150mg Effexor XR.  I feel like I have not emotion, having anxiety and fearful thoughts of death, something bad going to happen to my children, husband. I do not want to go to work or leave the house.  I feel wired.  Cannot relax or even take a nap. before the Abilify I was a complete wreck. Where can I be tested for Borna virus

Answer
Hi Jean . . .

The question of the possible role of Borna infection in causing psychiatric symptoms including those of bipolar disorder is an unanswered one. Part of the problem is that, as far as I can determine, Borna testing is not available through commercial laboratories in the USA. I have included information about Borna infection in my Depression Central site. See: http://www.psycom.net/depression.central.borna.html

Here an abstract of a study of the effects of the antiviral drug amantadine on patients with psychiatric symptoms:

Bipolar Disord. 2000 Mar;2(1):65-70.

Amantadine in depressive patients with Borna disease virus (BDV) infection: an open trial.
Dietrich DE, Bode L, Spannhuth CW, Lau T, Huber TJ, Brodhun B, Ludwig H, Emrich HM.

Department of Clinical Psychiatry and Psychotherapy, Medical School Hannover, Germany. dietrich.detlef@mh-hannover.de

Abstract
OBJECTIVE: Originally introduced into pharmacotherapy as an antiviral compound, amantadine was shown to also have multiple pharmacological effects on the central nervous system. In addition. only a few studies reported on certain antidepressive properties of amantadine. This effect was highlighted by the discovery of its antiviral effect on Borna disease virus (BDV), which is hypothesized to be an etiopathogenetic factor to subtypes of affective disorders. Therefore, the therapeutic use of amantadine in BDV-infected depressive patients was investigated.

METHODS: In this open trial, amantadine was added to antidepressive and or mood-stabilizing compounds treating BDV-infected depressed patients (n = 25) with bipolar or major depressive disorders. Amantadine was given twice a day (100-300 mg/day) for a mean of 11 weeks. Antidepressive treatment response was measured on the Hamilton rating scale for depression (HAM-D) and/or with an operationalized diagnostic criteria system (OPCRIT: version 3.31). Virological response was measured by expression of BDV infection parameters in blood samples.

RESULTS: The overall response rate of the amantadine augmentation in the BDV-infected patients with regard to depressive symptoms was 68% after a mean of 2.9 weeks of treatment. Bipolar I patients improved faster and did not show any following hypomania. In addition, the decrease of depression tended to correspond with the decrease in viral activity.

CONCLUSION: Amantadine appears to show a remarkable antidepressive efficacy in BDV-infected depressive patients. The antidepressive effect in this open trial appeared to be comparable to standard antidepressives, possibly being a result of its antiviral effect against BDV as a potentially relevant etiopathogenetic factor in these disorders.

PMID: 11254023 [PubMed - indexed for MEDLINE]

Best regards . . .

Ivan
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