Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-25T19:04:20.407Z Has data issue: false hasContentIssue false
  • English
  • Français

A factor analytic study in bipolar depression, and response to lamotrigine

Published online by Cambridge University Press:  23 May 2013

Philip B. Mitchell ,
Dusan Hadzi-Pavlovic ,
Gary Evoniuk ,
Joseph R. Calabrese  and
Charles L. Bowden
Philip B. Mitchell*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
Dusan Hadzi-Pavlovic
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
Gary Evoniuk
Affiliation:
GlaxoSmithKline Research and Development, Research Triangle Park, North Carolina, USA
Joseph R. Calabrese
Affiliation:
Mood Disorders Program, UH Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Charles L. Bowden
Affiliation:
Department of Psychiatry, The University of Texas Health Science Centre, San Antonio, Texas, USA
*
*Address for correspondence: Scientia Professor Philip Mitchell, Head, School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Randwick, NSW 2031, Australia. (Email [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

There have been no previous factor analytic studies of the Hamilton Depression Rating Scale (HDRS) in samples with bipolar I depression, and no investigations of the utility of any derived factors in determining treatment response in this condition. This study aimed to identify and compare factors of a 31-item version of the HDRS (HDRS-31) in large samples of patients with bipolar depression and Major Depressive Disorder (MDD), then examine the responsiveness of such factors to lamotrigine compared with placebo in the bipolar depressed sample.

Methods

This multivariate analytical study was performed on 2 large depressed samples (one bipolar and the other MDD) that had been recruited for separate, contemporaneous, double-blind placebo-controlled trials of lamotrigine. The 2 studies had similar designs and assessment tools, the major measures being the Montgomery–Asberg Depression Rating Scale (MADRS) and HDRS-31. To identify the constructs underlying the scale, exploratory factor analyses were conducted using HDRS-31 baseline scores. Treatment responsiveness in the bipolar depressed sample—as indicated by improvement in the total MADRS and HDRS-31, as well as HDRS factors—were examined using both a mixed-effects analysis and individual time-point t-tests.

Results

Seven factors of the HDRS-31 were identified: I—“depressive cognitions,” II—“psychomotor retardation,” III—“insomnia,” IV—“hypersomnia,” V—“appetite and weight change,” VI—“anxiety,” and VII—“anergia.” A significant therapeutic effect of lamotrigine in bipolar depression was found for the “depressive cognitions” factor (from week 3) and “psychomotor retardation” (from week 4).

Conclusion

This study has identified 7 factors of the HDRS in a large sample of patients with bipolar depression. The results suggest that that the clinical benefits of lamotrigine in acute bipolar depression are primarily upon depressive cognitions and psychomotor slowing.

Keywords

Bipolar depressionfactor analysislamotriginemajor depressive disordermultivariate statistics
Type
Original Research
Information
CNS Spectrums , Volume 18 , Issue 4 , August 2013 , pp. 214 - 224
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The research activities of Philip Mitchell and Dusan Hadzi-Pavlovic are supported by the Australian National Health and Medical Research Council through Program Grant number 510135.

References

1.Bowden, CL. A different depression: clinical distinctions between bipolar and unipolar depression. J Affect Disord. 2005; 84(2–3): 117–125.CrossRefGoogle ScholarPubMed
2.Frye, MA. Clinical practice: bipolar disorder—a focus on depression. N Engl J Med. 2011; 364(1): 51–59.CrossRefGoogle ScholarPubMed
3.Mitchell, PB, Frankland, A, Hadzi-Pavlovic, D, etal. Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees. Br J Psychiatry. 2011; 199(4): 303–309.CrossRefGoogle ScholarPubMed
4.Judd, LL, Akiskal, HS, Schttler, PJ. The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry. 2002; 59(6): 530–537.CrossRefGoogle ScholarPubMed
5.Judd, LL, Akiskal, HS, Schttler, PJ. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry. 2003; 60(3): 261–269.CrossRefGoogle ScholarPubMed
6.Bauer, MS, Kirk, GF, Gavin, C. Determinants of functional outcome and healthcare costs in bipolar disorder: a high-intensity follow-up study. J Affect Disord. 2001; 65(3): 231–241.CrossRefGoogle ScholarPubMed
7.Judd, LL, Akiskal, HS, Schettler, PJ, etal. Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study. Arch Gen Psychiatry. 2005; 62(12): 1322–1331.CrossRefGoogle ScholarPubMed
8.Nierenberg, AA, Ostacher, MJ, Calabrese, JR, etal. Treatment-resistant bipolar depression: a STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotrigine, inositol or risperidone. Am J Psychiatry. 2006; 163(2): 210–216.CrossRefGoogle ScholarPubMed
9.Leverich, GS, Altshuler, LL, Frye, MA, etal. Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. Am J Psychiatry. 2006; 163(2): 232–239.CrossRefGoogle ScholarPubMed
10.Parker, G, Roy, K, Wilhelm, K, etal. The nature of bipolar depression: implications for the definition of melancholia. J Affect Disord. 2002; 59(3): 217–224.CrossRefGoogle Scholar
11.Mitchell, PB, Wilhelm, K, Parker, G, etal. The clinical features of bipolar depression: a comparison with matched major depressive disorder patients. J Clin Psychiatry. 2001; 62(3): 212–216.CrossRefGoogle ScholarPubMed
12.Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23(1): 56–62.CrossRefGoogle ScholarPubMed
13.Hamilton, M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967; 6(4): 278–296.CrossRefGoogle ScholarPubMed
14.Parker, G, Hadzi-Pavlovic, D, Boyce, P, etal. Classifying depression by mental state signs. Br J Psychiatry. 1990; 157(1): 55–64.CrossRefGoogle ScholarPubMed
15.Parker, G, Hadzi-Pavlovic, D, Wilhelm, K, etal. Defining melancholia: properties of a refined sign-based measure. Br J Psychiatry. 1994; 164(3): 316–326.CrossRefGoogle ScholarPubMed
16.Benazzi, F. Factor analysis of the Montgomery Asberg Depression Rating Scale in 251 bipolar II and 306 unipolar depressed outpatients. Prog Neuropsychopharmacol Biol Psychiatry. 2001; 25(7): 1369–1376.CrossRefGoogle ScholarPubMed
17.Montgomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134(4): 382–389.CrossRefGoogle ScholarPubMed
18.Hantouche, EG, Akiskal, HS. Bipolar II vs. unipolar depression: psychopathologic differentiation by dimensional measures. J Affect Disord. 2005; 84(2–3): 127–132.CrossRefGoogle ScholarPubMed
19.Thompson, PM, Gonzalez, JM, Singh, V, etal. Principal domains of behavioral psychopathology identified by the Bipolar Inventory of Signs and Symptoms Scale (BISS). Psychiatry Res. 2010; 175(3): 221–226.CrossRefGoogle ScholarPubMed
20.Bowden, CL, Calabrese, JR, Sachs, G. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. Arch Gen Psychiatry. 2003; 60(4): 392–400.CrossRefGoogle ScholarPubMed
21.Calabrese, JR, Bowden, CL, Sachs, G. A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. J Clin Psychiatry. 2003; 64(9): 1013–1024.CrossRefGoogle ScholarPubMed
22.Calabrese, JR, Bowden, CL, Sachs, GS. A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. J Clin Psychiatry. 1999; 60(2): 79–88.CrossRefGoogle ScholarPubMed
23.Geddes, JR, Calabrese, JR, Goodwin, GM. Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. Br J Psychiatry. 2009; 194(1): 4–9.CrossRefGoogle ScholarPubMed
24.Laurenza, A, Asnis, G, Beaman, M, etal. A double-blind, placebo-controlled study supporting the efficacy of lamotrigine in unipolar depression. Bipolar Disord. 1999; 1(S1): 39–40.Google Scholar
25.Jamerson, BD, Krishnan, KRR, Roberts, J. Effect of bupropion SR on specific symptom clusters of depression: analysis of the 31-item Hamilton Rating Scale for Depression. Psychopharmacol Bull. 2003; 37(2): 67–78.Google ScholarPubMed
26.Bech, P, Allerup, P, Gram, LF. The Hamilton Depression Scale: evaluation of objectivity using logistic models. Acta Psychiatr Scand. 1981; 63(3): 290–299.CrossRefGoogle ScholarPubMed
27.Gibbons, RD, Clark, DC, Kupfer, DJ. Exactly what does the Hamilton Depression Rating Scale measure? J Psychiatr Res. 1993; 27(3): 259–273.CrossRefGoogle ScholarPubMed
28.Butler, DC, Gock, EF, Hartley, JA. Analysis of factor variance: two cases. Psychol Rep. 1972; 31(1): 267–279.CrossRefGoogle Scholar
29.Browne, MW, Cudeck, R, Tateneni, K. CEFA: Comprehensive Exploratory Factor Analysis Version 1.03. Ohio State University; 1999.Google Scholar
30.Muthen, LK, Muthen, BO. Mplus User's Guide. Los Angeles, CA: Muthen & Muthen; 1998.Google Scholar
31.Joreskog, KG, Sorbom, D. LISREL 8 User's Reference Guide. Chicago: Scientific Software International; 1996.Google Scholar
32.Insightful Corporation. S-Plus 6 for Windows Guide to Statistics, Volume I. Seattle, WA: Insightful Corporation; 2001.Google Scholar
33.Cudeck R0. Exploratory factor analysis. In Tinsley HEA, Brown, SD, eds. Handbook of Applied Multivariate Statistics and mathematical Modeling. San Diego, CA: Academic Press; 2000: 265–296.CrossRefGoogle Scholar
34.Angst, J, Azorin, JM, Bowden, CL, etal. BRIDGE Study Group. Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Arch Gen Psychiatry. 2011; 68(8): 791–798.CrossRefGoogle Scholar
35.Swann, CA, Bowden, CL, Calabrese, RJ. Pattern of response to divalproex, lithium, or placebo in four naturalistic subtypes of mania. Neuropsychopharmacology. 2002; 26(4): 529–536.CrossRefGoogle ScholarPubMed
36.Frye, MA, Ketter, TA, Kimbrell, TA. A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory mood disorders. J Clin Psychopharmacol. 2000; 20(6): 607–614.CrossRefGoogle ScholarPubMed
37.Obrocea, GV, Dunn, RM, Frye, MA. Clinical predictors of response to lamotrigine and gabapentin monotherapy in refractory affective disorders. Biol Psychiatry. 2002; 51(3): 253–260.CrossRefGoogle ScholarPubMed
38.Xiang, YT, Zhang, L, Wang, G, etal. Sociodemographic and clinical features of bipolar disorder patients misdiagnosed with major depressive disorder in China. Bipolar Disord. 2013; 15(2): 199–205.CrossRefGoogle ScholarPubMed