Patterns of changes in bipolar depressive symptoms revealed by trajectory analysis among 482 patients with bipolar disorder
Autor: | Michael E. Thase, Louisa G. Sylvia, Andrew A. Nierenberg, Holger J. Sørensen, Richard C. Shelton, Susan L. McElroy, Mauricio Tohen, Edward S. Friedman, Ole Köhler-Forsberg, Melvin G. McInnis, Keming Gao, Charles L. Bowden, William V. Bobo, Trine Madsen, Masoud Kamali, James H. Kocsis, Joseph R. Calabrese, Ida Behrendt-Møller, Terence A. Ketter, Thilo Deckersbach, Noreen A. Reilly-Harrington |
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Rok vydání: | 2018 |
Předmět: |
Male
Bipolar Disorder Lithium (medication) Bipolar Disorder/diagnosis Antidepressive Agents/therapeutic use 0302 clinical medicine depressive symptoms Prevalence ANXIETY PREDICTORS Depression (differential diagnoses) bipolar disorder Depression Quetiapine Fumarate/therapeutic use Prognosis CHOICE Antidepressive Agents Psychiatry and Mental health Treatment Outcome ADOLESCENCE Lithium Compounds Female Drug Monitoring OUTPATIENTS Drug Monitoring/methods medicine.drug Adult medicine.medical_specialty Randomization PRIMARY-CARE PATIENTS 03 medical and health sciences Quetiapine Fumarate Rating scale Depression/diagnosis Internal medicine medicine trajectories Humans Bipolar disorder QUETIAPINE Biological Psychiatry Depressive symptoms TREATMENT RESPONSE Lithium Compounds/therapeutic use Psychiatric Status Rating Scales business.industry ANTIDEPRESSANT NATURAL-HISTORY medicine.disease 030227 psychiatry Clinical trial Quetiapine growth mixture modeling business 030217 neurology & neurosurgery |
Zdroj: | Köhler-Forsberg, O 2018, ' Patterns of changes in bipolar depressive symptoms revealed by trajectory analysis among 482 patients with bipolar disorder. ' Bipolar Disorders . https://doi.org/10.1111/bdi.12715 Behrendt-Møller, I, Madsen, T, Sørensen, H J, Sylvia, L, Friedman, E S, Shelton, R C, Bowden, C L, Calabrese, J R, McElroy, S L, Ketter, T A, Reilly-Harrington, N A, Gao, K, Thase, M, V Bobo, W, Tohen, M, McInnis, M, Kamali, M, Kocsis, J H, Deckersbach, T, Köhler-Forsberg, O & Nierenberg, A A 2019, ' Patterns of changes in bipolar depressive symptoms revealed by trajectory analysis among 482 patients with bipolar disorder ', Bipolar disorders, vol. 21, no. 4, pp. 350-360 . https://doi.org/10.1111/bdi.12715 |
ISSN: | 1399-5618 |
Popis: | INTRODUCTION: Depressive episodes are often prevalent among patients with bipolar disorder, but little is known regarding the differential patterns of development over time. We aimed to determine and characterize trajectories of depressive symptoms among adults with bipolar disorder during 6 months of systematic treatment.METHODS: The pragmatic clinical trial, Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (CHOICE), randomized 482 outpatients with bipolar disorder to lithium or quetiapine. Depressive symptoms were rated at up to 9 visits using the Montgomery-Asberg Depression Rating Scale (MADRS). Growth mixture modeling was utilized to identify trajectories and multinomial regression analysis estimated associations with potential predictors.RESULTS: Four distinct trajectories of depressive symptoms were identified. The responding class (60.3%) with a rapid reduction and subsequent low level; the partial-responding class (18.4%) with an initial reduction followed by an increase during the remaining weeks; the fluctuating class (11.6%) with a fluctuation in depressive symptoms; and the non-responding class (9.7%) with sustained moderate-severe depressive symptoms. Bipolar type I predicted membership of the non-responding class and randomization to quetiapine predicted membership of either the responding or the non-responding class.CONCLUSION: Approximately 30% experienced a partial or fluctuating course, and almost 10% had a chronic course with moderate-severe depression during 6 months. Patients diagnosed with bipolar type 1 had higher risk of being categorized into a class with a worse outcome. While no differences in average overall outcomes occurred between the lithium and quetiapine groups, trajectory analysis revealed that the lithium group had more variable courses. |
Databáze: | OpenAIRE |
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