scholarly journals Mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Christoph Born ◽  
Heinz Grunze ◽  
Robert M. Post ◽  
Lori L. Altshuler ◽  
Ralph Kupka ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Bipolar Depression ◽  
Correlation Coefficients ◽  
Post Hoc Analysis ◽  
Dsm 5 ◽  
Mixed Features ◽  
Symptom Load ◽  
Patient Groups ◽  
Sum Scores ◽  
Post Hoc

Abstract Background Depending on the classification system used, 5–40% of manic subjects present with concomitant depressive symptoms. This post-hoc analysis evaluates the hypothesis that (hypo)manic subjects have a higher burden of depression than non-(hypo)manic subjects. Methods Data from 806 Bipolar I or II participants of the Stanley Foundation Bipolar Network (SFBN) were analyzed, comprising 17,937 visits. A split data approach was used to separate evaluation and verification in independent samples. For verification of our hypotheses, we compared mean IDS-C scores ratings of non-manic, hypomanic and manic patients. Data were stored on an SQL-server and extracted using standard SQL functions. Linear correlation coefficients and pivotal tables were used to characterize patient groups. Results Mean age of participants was 40 ± 12 years (range 18–81). 460 patients (57.1%) were female and 624 were diagnosed as having bipolar I disorder (77.4%) and 182 with bipolar II (22.6%). Data of 17,937 visits were available for analyses, split into odd and even patient numbers and stratified into three groups by YMRS-scores: not manic < 12, hypomanic < 21, manic < 30. Average IDS-C sum scores in manic or hypomanic states were significantly higher (p < .001) than for non-manic states. (Hypo)manic female patients were likely to show more depressive symptoms than males (p < .001). Similar results were obtained when only the core items of the YMRS or only the number of depressive symptoms were considered. Analyzing the frequency of (hypo)manic mixed states applying a proxy of the DSM-5 mixed features specifier extracted from the IDS-C, we found that almost 50% of the (hypo)manic group visits fulfilled DSM-5 mixed features specifier criteria. Conclusion Subjects with a higher manic symptom load are also significantly more likely to experience a higher number of depressive symptoms. Mania and depression are not opposing poles of bipolarity but complement each other.

Treatment of mixed features in bipolar disorder

CNS Spectrums ◽  
2016 ◽  
Vol 22 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Joshua D. Rosenblat ◽  
Roger S. McIntyre
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Treatment Resistance ◽  
Course Of Illness ◽  
Stabilizing Agents ◽  
Dsm 5 ◽  
Mixed Features ◽  
Post Hoc ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Mood episodes with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)–defined mixed features are highly prevalent in bipolar disorder (BD), affecting ~40% of patients during the course of illness. Mixed states are associated with poorer clinical outcomes, greater treatment resistance, higher rates of comorbidity, more frequent mood episodes, and increased rates of suicide. The objectives of the current review are to identify, summarize, and synthesize studies assessing the efficacy of treatments specifically for BD I and II mood episodes (ie, including manic, hypomanic, and major depressive episodes) with DSM-5–defined mixed features. Two randomized controlled trials (RCTs) and 6 post-hoc analyses were identified, all of which assessed the efficacy of second-generation antipsychotics (SGAs) for the acute treatment of BD mood episodes with mixed features. Results from these studies provide preliminary support for SGAs as efficacious treatments for both mania with mixed features and bipolar depression with mixed features. However, there are inadequate data to definitively support or refute the clinical use of specific agents. Conventional mood stabilizing agents (eg, lithium and divalproex) have yet to have been adequately studied in DSM-5–defined mixed features. Further study is required to assess the efficacy, safety, and tolerability of treatments specifically for BD mood episodes with mixed features.

Aripiprazole in bipolar depression: a pooled, post-hoc analysis by severity of core depressive symptoms

2012 ◽  
Vol 16 (2) ◽  
pp. 121-131 ◽  
Author(s):  
Michael E. Thase ◽  
Charles L. Bowden ◽  
Michael Nashat ◽  
James M. Eudicone ◽  
Ronald Marcus ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Bipolar Depression ◽  
Post Hoc Analysis ◽  
Post Hoc

scholarly journals 160 Lurasidone and Metabolic Syndrome: Results from Short- and Long-Term Clinical Studies in Patients with Bipolar Depression

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 302-303
Author(s):  
Michael Tocco ◽  
John W. Newcomer ◽  
Yongcai Mao ◽  
Andrei Pikalov
Keyword(s):  
Metabolic Syndrome ◽  
Adjunctive Therapy ◽  
Bipolar Depression ◽  
Prevention Study ◽  
Short Term ◽  
Post Hoc Analysis ◽  
Short And Long Term ◽  
Post Hoc ◽  
Therapy Studies

Abstract:Background:Among patients with depressive disorders, the prevalence of metabolic syndrome (MetS) is estimated to range from 35-40% and has been associated with increased mortality rates. The aim of this post-hoc analysis was to assess the effect of treatment with lurasidone on the prevalence of MetS in patients with bipolar depression.Method:Lurasidone data (dose range, 20-120 mg/d) used in the current analyses consisted of 3 double-blind (DB), placebo-controlled, 6-week studies in adults with bipolar I depression (total N=1,192), consisting of 1 monotherapy, and 2 adjunctive therapy trials with lithium or valproate. Patients who completed the short-term trials continued into a 6-month open-label (OL) extension study, with 6-month (LOCF-endpoint) data available on 274 patients treated with lurasidone monotherapy, and 436 patients treated with lurasidone adjunctive therapy. Also analyzed was a recurrence prevention study in stabilized bipolar patients who completed up to 20 weeks of OL adjunctive treatment with lurasidone, and then were randomized to 28 weeks of DB adjunctive therapy with lurasidone or placebo (N=497). MetS was defined based on NCEP ATP III criteria (2005 revision).Results:In the short-term monotherapy and adjunctive therapy studies, the proportion of patients at baseline meeting NCEP III criteria for MetS were 27.6% and 23.6%, respectively, for lurasidone, and 23.8% and 25.1%, respectively, for placebo; and at week 6 (LOCF) the proportion with MetS was 27.5% and 26.6%, respectively, for lurasidone and 29.9% and 20.2%, respectively, for placebo. The proportion of patients who did not meet MetS criteria at baseline but developed MetS at week 6 (LOCF) was similar for lurasidone vs. placebo in the monotherapy study (9.9% vs. 11.6%); and in the two adjunctive therapy studies (10.3% vs. 8.3%). During the 6-month OL extension study, the proportion of patients treated with lurasidone monotherapy and adjunctive therapy who did not meet MetS criteria at OL baseline but developed MetS at month 6 (LOCF) was 11.7% and 11.9%, respectively. Conversely, the proportion of patients who met MetS criteria at OL baseline, but no longer met criteria at month 6 (LOCF) was 9.5% and 7.7%, respectively. In the 20-week, OL phase of the recurrence prevention study, the proportion of patients treated with adjunctive lurasidone who did not meet MetS criteria at OL baseline but developed MetS at endpoint was 11.5% (LOCF). After up to 28 weeks of DB treatment, the proportion of patients who did not meet MetS criteria at DB baseline but developed MetS at endpoint was 9.0% in the adjunctive lurasidone group, and 10.5% in the adjunctive placebo group (LOCF).Conclusion:This post-hoc analysis found that short- and long-term treatment with lurasidone was associated with a relatively low risk for the development of metabolic syndrome in patients with bipolar I disorder. These findings are consistent with similar analyses in patients with schizophrenia.Funding Acknowledgements:Supported by funding from Sunovion Pharmaceuticals Inc.

scholarly journals A pooled post hoc analysis evaluating the safety and tolerability of cariprazine in bipolar depression

2020 ◽  
Vol 263 ◽  
pp. 386-395
Author(s):  
Willie R. Earley ◽  
Maria Burgess ◽  
Ludmyla Rekeda ◽  
Arlene Hankinson ◽  
Roger S. McIntyre ◽  
...  
Keyword(s):  
Bipolar Depression ◽  
Post Hoc Analysis ◽  
Post Hoc
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