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Treatment-Resistant Bipolar Disorder: A Comparison of Rapid Cyclers and Nonrapid Cyclers

Published online by Cambridge University Press:  07 November 2014

Dong Vo  and
David L. Dunner
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Abstract

Background: We investigated clinical factors to determine their relationship to treatment resistance among bipolar patients who had a consultation at a tertiary care facility.

Methods: Patients were separated into two categories: rapid-cycling disorders and nonrapid-cycling disorders. We hypothesized that there would be less usage of lithium carbonate among nonrapid-cycling treatment-resistant patients than among rapid cyclers and also that there would be higher rates of comorbidity seen among nonrapid-cycling than rapid-cycling patients in order to account for these particular patients being treatment resistant.

Findings: Continued recyling and persistent depression characterized rapid cyclers, whereas persistent depression characterized nonrapid cyclers. Less than 30% of patients had adequate lithium treatment and there was no significant difference comparing rapid cyclers with non-rapid cyclers. Rates of comorbidity were also not significantly different between these groups. We also assessed a number of other factors.

Conclusion: Some of these factors were significant, but when a Bonferonni correction was applied, these significant differences were not maintained. The study of treatment resistance among nonrapid-cycling bipolar patients merits further research.

Type
Original Research
Information
CNS Spectrums , Volume 8 , Issue 12: Bipolar Mood Disorder: Recent Developments Across the Spectrum , December 2003 , pp. 948 - 952
Copyright
Copyright © Cambridge University Press 2003

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References

REFERENCES

1.Dunner, DL, Fieve, RR.The effect of lithium in depressive subtypes. Deniker, P, Radouco-Thomas, C, Villenueve, AI, eds. Vol. 2. Neuropsychopharmacobgy. New York, NY: Pergamon Press, 1978:1109–1115.Google Scholar
2.Stancer, HC, Furlong, FW, Godse, DD.A longitudinal investigation of lithium as a prophylactic agent for recurrent depression. Can Psychiatric Assoc J. 1970;15:29–40.CrossRefGoogle Scholar
3.Dunner, DL, Fieve, RR.Clinical factors in lithium carbonate prophylaxis failure. Arch Gen Psychiatry. 1974;30:229–233.CrossRefGoogle ScholarPubMed
4.Goodwin, FK, Jamison, KR.Manic Depressive illness. Oxford, England: Oxford University Press; 1990.Google Scholar
5.Nemeroff, CB, Evans, DL, Gyulai, L, et al.Double-blind, placebo-controlled comparison of Imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry. 2001;158:906–912.CrossRefGoogle ScholarPubMed
6.Fieve, RR, Dunner, DL, Kumbaraci, T, et al.Lithium carbonate prophylaxis of depression in three subtypes of primary affective disorder. Pharmako Psychiatrik Neurophychopharmakolgie. 1976;9:100–107.CrossRefGoogle ScholarPubMed
7.Tondo, L, Baldessarini, RJ, Hennen, J, et al.Lithium treatment and risk of suicidal behavior in bipolar disorder patients. J Clin Psychiatry. 1998;59:405–414.CrossRefGoogle ScholarPubMed
8.Dunner, DL. Diagnostic assessment. Psychiatric Clin N Amer. 1993;16:431–441.CrossRefGoogle ScholarPubMed
9.Hick, SM, Roy-Byrne, PP, Cowley, DS, et al.DSM-III-R personality disorders in a mood and anxiety disorders clinic: prevalence, comorbitity, and clinical correlates. J Affect Disord. 1993;27:71–79.Google Scholar
10.Hamilton, M. The assessment of anxiety by rating. Br J Med Psychol. 1959;32:50–56.CrossRefGoogle ScholarPubMed
11.Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.CrossRefGoogle ScholarPubMed
12.Montgomery, SA, Asberg, M.A new depression rating scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–389.CrossRefGoogle ScholarPubMed
13.Rosenthal, NE, Sack, DA, Gillin, JC, et al.Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry. 1984;41:72–80.CrossRefGoogle ScholarPubMed
14.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
15.Bowden, CL, Brugger, AM, Swann, AC, et al.Efficacy of divalproex vs lithium in the treatment of mania. The Depakote Mania Study Group. JAMA. 1994;271:918–924.Google ScholarPubMed
16.Calabrese, JR, Bowden, CL, Sachs, GS, et al.A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group. J Clin Psychiatry. 1999;60:79–88.CrossRefGoogle ScholarPubMed
17.Practice guideline for the treatment of patients with bipolar disorder (Revision). Am J Psychiatry. 2002;159:1–50.Google Scholar
18.Baker, RW, Vieta, E, Ketter, TA, et al.Olanzapine and olanzapine-fluoxetine combination (OFC) in the treatment of bipolar depression. Paper presented: Annual Meeting of the American College of Neuropsychopharmacology; 12 8-12, 2002; San Juan, PR.Google Scholar
19.Tohen, M, Marneros, A, Bowden, C, et al.Olanzapine versus lithium in relapse prevention: a randomized double blind controlled 12-month clinical trial. Paper presented at: Annual Meeting of the American College of Neuropsychopharmacology; 12 8–12, 2002; San Juan PR.Google Scholar
20.Himmelhoch, JM, Thase, ME, Mallinger, AG, et al.Tranylcypromine versus imipramine in anergic bipolar depression. Am J Psychiatry. 1991;148:910–916.Google ScholarPubMed
21.Cohn, JB, Collins, G, Ashbrook, E, et al.A comparison of fluoxetine imipramine and placebo in patients with bipolar depressive disorder, Int Clin Psychopharmacol. 1989;4:313–322.CrossRefGoogle ScholarPubMed
22.Sachs, GS, Later, B, Stoll, AL, et al.A double-blind trial of bupropion versus desipramine for bipolar depression. J Clin Psychiatry. 1994;55:391–393.Google ScholarPubMed
23.Peet, M. Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants. Br J Psychiatry. 1994;164:549–550.CrossRefGoogle ScholarPubMed
24.Amsterdam, J. Efficacy and safety of venlafaxine in the treatment of bipolar II major depressive episode. J Clin Psychopharmacol. 1998;18:414–417.CrossRefGoogle ScholarPubMed
25.Bowden, CL, Calabrese, JR, McElroy, SL, et al.A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group. Arch Gen Psychiatry. 2000;57:481–489.CrossRefGoogle ScholarPubMed
26.Dunner, DL, Stallone, F, Fieve, RR.Lithium carbonate and affective disorders. V. A double-blind study of prophylaxis of depression in bipolar illness. Arch Gen Psychiatry. 1976;33:117–120.CrossRefGoogle Scholar
27.Dunner, DL, Stallone, F, Fieve, RR.Prophylaxis with lithium carbonate: an update. Arch Gen Psychiatry. 1982;39;1344–1345.Google ScholarPubMed
28.Cole, AJ, Scott, J, Ferrier, IN.Patterns of treatment resistance in bipolar affective disorder. Acta Psychiatrica Scand. 1993;88:121–123.CrossRefGoogle ScholarPubMed
29.Sachs, GS. Treatment-resistant bipolar depression. Psychiatr Clin N Am. 1996;19:215–236.CrossRefGoogle ScholarPubMed
30.Nelsen, MR, Dunner, DL.Clinic and differential diagnostic aspects of treatment resistant depression. J Psych Research. 1995;29:43–50.CrossRefGoogle ScholarPubMed