The long-term natural history of the weekly symptomatic status of bipolar I disorder.
Lewis L. Judd,Hagop S. Akiskal,Pamela J. Schettler,Jean Endicott,Jack D. Maser,David A. Solomon,Andrew C. Leon,John A. Rice,Martin B. Keller +8 more
TLDR
Overall, the symptomatic structure is primarily depressive rather than manic, and subsyndromal and minor affective symptoms predominate, and the longitudinal weekly symptomatic course of BP-I is chronic.Abstract:
Background To our knowledge, this is the first prospective natural history study of weekly symptomatic status of patients with bipolar I disorder (BP-I) during long-term follow-up. Methods Analyses are based on ongoing prospective follow-up of 146 patients with Research Diagnostic Criteria BP-I, who entered the National Institute of Mental Health (Bethesda, Md) Collaborative Depression Study from 1978 through1981. Weekly affective symptom status ratings were analyzed by polarity and severity, ranging from asymptomatic, to subthreshold levels, to full-blown major depression and mania. Percentages of follow-up weeks at each level as well as number of shifts in symptom status and polarity during the entire follow-up period were examined. Finally, 2 new measures of chronicity were evaluated in relation to previously identified predictors of chronicity for BP-I. Results Patients with BP-I were symptomatically ill 47.3% of weeks throughout a mean of 12.8 years of follow-up. Depressive symptoms (31.9% of total follow-up weeks) predominated over manic/hypomanic symptoms (8.9% of weeks) or cycling/mixed symptoms (5.9% of weeks). Subsyndromal, minor depressive, and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms (29.9% vs 11.2% of weeks, respectively). Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year. Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up, as did comorbid drug-use disorder. Conclusions The longitudinal weekly symptomatic course of BP-I is chronic. Overall, the symptomatic structure is primarily depressive rather than manic, and subsyndromal and minor affective symptoms predominate. Symptom severity levels fluctuate, often within the same patient over time. Bipolar I disorder is expressed as a dimensional illness featuring the full range (spectrum) of affective symptom severity and polarity.read more
Citations
More filters
Journal ArticleDOI
A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder.
Lewis L. Judd,Hagop S. Akiskal,Pamela J. Schettler,William Coryell,Jean Endicott,Jack D. Maser,David A. Solomon,Andrew C. Leon,Martin B. Keller +8 more
TL;DR: The longitudinal symptomatic course of BP-II is chronic and is dominated by depressive rather than hypomanic or cycling/mixed symptoms, involving primarily symptoms of minor and subsyndromal severity.
Journal ArticleDOI
Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology
Guy M. Goodwin,Peter M. Haddad,I. N. Ferrier,Jeffrey K Aronson,T R H Barnes,Andrea Cipriani,David Coghill,Seena Fazel,John R. Geddes,Heinz Grunze,Emily A. Holmes,Oliver D. Howes,S. Hudson,N. Hunt,Ian Jones,Iain Macmillan,H. McAllister-Williams,D. R. Miklowitz,Richard Morriss,Marcus R. Munafò,Carol Paton,B. J. Saharkian,Kate E. A. Saunders,Julia Sinclair,David Taylor,Eduard Vieta,Allan H. Young +26 more
TL;DR: The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder, and recommend strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment.
Journal ArticleDOI
Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder
Lakshmi N. Yatham,Sidney H. Kennedy,Sagar V. Parikh,Ayal Schaffer,David J. Bond,Benicio N. Frey,Verinder Sharma,Benjamin I. Goldstein,Soham Rej,Serge Beaulieu,Martin Alda,Glenda MacQueen,Roumen Milev,Arun V. Ravindran,Claire O'Donovan,Diane McIntosh,Raymond W. Lam,Gustavo Vazquez,Flávio Kapczinski,Roger S. McIntyre,Jan Marie Kozicky,Shigenobu Kanba,Beny Lafer,Trisha Suppes,Joseph R. Calabrese,Eduard Vieta,Gin S Malhi,Robert M. Post,Michael Berk +28 more
TL;DR: These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments.
Journal ArticleDOI
Targeting the glutamatergic system to develop novel, improved therapeutics for mood disorders
TL;DR: There is growing evidence that the glutamatergic system is central to the neurobiology and treatment of mood disorders and exciting new prospects for the development of improved therapeutics for these devastating disorders are discussed.
Journal ArticleDOI
Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression
Gary S. Sachs,Andrew A. Nierenberg,Joseph R. Calabrese,Lauren B. Marangell,Stephen R. Wisniewski,Laszlo Gyulai,Edward S. Friedman,Charles L. Bowden,Mark D. Fossey,Michael J. Ostacher,Terence A. Ketter,Jayendra K. Patel,Peter Hauser,Daniel Rapport,James M. Martinez,Michael H. Allen,David J. Miklowitz,Michael W. Otto,Ellen B. Dennehy,Michael E. Thase +19 more
TL;DR: The use of adjunctive, standard antidepressant medication, as compared with the use of mood stabilizers, was not associated with increased efficacy or with increased risk of treatment-emergent affective switch.
References
More filters
Book
Manic-depressive insanity and paranoia
TL;DR: A facsimile reprinting of Kraepelin's great German textbook, "Manic-Depressive Insanity and Paranoia" (1921), which showed for the first time that psychotic depression could have alternating forms of mania and severe melancholy.
Journal ArticleDOI
The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies
Martin B. Keller,Philip W. Lavori,Barbara Friedman,Eileen Nielsen,Jean Endicott,Pat McDonald-Scott,Nancy C. Andreasen +6 more
TL;DR: The Longitudinal Interval Follow-up Evaluation (LIFE) is an integrated system for assessing the longitudinal course of psychiatric disorders that consists of a semistructured interview, an Instruction booklet, a coding sheet, and a set of training materials.
Journal ArticleDOI
A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders.
Lewis L. Judd,Hagop S. Akiskal,Jack D. Maser,Pamela J. Zeller,Jean Endicott,William Coryell,Martin P. Paulus,Jelena L. Kunovac,Andrew C. Leon,Timothy I. Mueller,John A. Rice,Martin B. Keller +11 more
TL;DR: The long-term weekly course of unipolar MDD is dominated by prolonged symptomatic chronicity, and MDD, MinD, and SSD symptom levels commonly alternate over time in the same patients as a symptomatic continuum of illness activity of a single clinical disease.
Journal ArticleDOI
Switching from 'unipolar' to bipolar II. An 11-year prospective study of clinical and temperamental predictors in 559 patients.
Hagop S. Akiskal,Jack D. Maser,Pamela J. Zeller,Jean Endicott,William Coryell,Martin B. Keller,Meredith G. Warshaw,Paula J. Clayton,Frederick K. Goodwin +8 more
TL;DR: The profile of patients with MDD who would convert to the more subtle bipolar subtype (known as BPII) on the basis of clinical and personality variables obtained during MDD episodes was associated with early age at onset of MDD and pleomorphic psychopathology beyond the usual affective realm.
Journal ArticleDOI
Antidepressant-induced mania and cycle acceleration: a controversy revisited.
Lori L. Altshuler,Robert M. Post,Gabriele S. Leverich,Kirstin Mikalauskas,Ann Rosoff,Laura Ackerman +5 more
TL;DR: Antidepressant-induced mania may be a marker for increased vulnerability to antidepressant-induced cycle acceleration and is associated with younger age at first treatment and may be more likely to occur in women and in bipolar II patients.