Add-On Ramelteon in Bipolar I Disorder With Clinically Significant Sleep Disturbance

This is a randomized, double-blind, placebo-controlled, parallel-group, single site, 8-week
trial of add-on ramelteon in outpatient adults (18-65 years old, inclusive) with lifetime
bipolar I disorder, with mild to moderate manic symptoms, and currently experiencing a
clinically significant sleep disturbance. Approximately 60 subjects will be screened to
obtain 30 subjects who enroll in the 8-week trial. Subjects will be randomized to ramelteon
or placebo in a double-blind manner as add-on to current treatment. Any other psychotropic
medications that the subject is taking at the initiation of participation in this protocol
should be continued unchanged throughout the course of this study, except in instances in
which these medications require dose reduction for management of side effects. Efficacy and
safety assessments will be performed weekly, and the presence of treatment-emergent adverse
events will be monitored and recorded.

Inclusion Criteria:

1. Subjects must be 18 to 65 years of age, inclusive.

2. Subjects must have lifetime bipolar I disorder as defined by DSM-IV-TR criteria.

3. Subjects' manic symptoms must be mild to moderate in severity, defined as an YMRS
score between 10 and 25.

4. Subjects must be currently experiencing a clinically significant sleep disturbance,
defined as a PSQI total score > 5.

5. Subjects must be receiving at least 1 mood stabilizing medication, which may include
an atypical antipsychotic (e.g., aripiprazole, clozapine, olanzapine, quetiapine,
risperidone, ziprasidone) and/or mood stabilizer/anticonvulsant (e.g, lithium,
carbamazepine, valproate/divalproex, lamotrigine, oxcarbazepine) medication for > 1
week prior to baseline. Continued administration of benzodiazepines or
sedative-hypnotics will be allowed only if the subject has been receiving the
medication for > 2 weeks prior to baseline.

6. Subjects or their legally authorized representative must sign the Informed Consent
Document after the nature of the trial has been fully explained.

7. If female, subjects must be: postmenopausal, surgically incapable of childbearing, or
practicing medically acceptable effective method(s) of contraception (e.g., hormonal
methods, barrier methods, intrauterine device) for at least 1 month prior to study
entry and throughout the study.

Exclusion Criteria:

1. Subjects who are experiencing clinically significant suicidal or homicidal ideation.

2. Subjects who are currently experiencing psychotic symptoms.

3. Subjects with a current DSM-IV-TR Axis I diagnosis of delirium, dementia, amnesia, or
other cognitive disorders; a DSM-IV-TR diagnosis of a substance dependence disorder
within the past 6 months; or, a lifetime DSM-IV-TR psychotic disorder (e.g.,
schizophrenia or schizoaffective disorder).

4. Subjects with serious general medical illnesses including hepatic, renal, respiratory,
cardiovascular, endocrine, neurologic, or hematologic disease as determined by the
clinical judgment of the investigator.

5. Subjects with hypo- or hyperthyroidism unless stabilized on thyroid replacement for >
3 months.

6. Subjects with a clinically significant abnormality in their pre-study physical exam,
vital signs, EKG, or laboratory studies.

7. Subjects who are allergic to or who have demonstrated hypersensitivity to ramelteon.

8. Subjects who are taking medications that interact with ramelteon (e.g., ketoconazole,
fluconazole, fluvoxamine, rifampin).

9. Females who are pregnant or nursing.

10. Subjects who have received an experimental drug or used an experimental device within
30 days.