Current Psychiatry Reports

, Volume 8, Issue 6, pp 489–497 | Cite as

New findings from the bipolar collaborative network: Clinical implications for therapeutics

  • Robert M. Post
  • Lori L. Altshuler
  • Mark A. Frye
  • Trisha Suppes
  • Susan McElroy
  • Paul E. KeckJr
  • Gabriele S. Leverich
  • Ralph Kupka
  • Willem A. Nolen
  • Heinz Grunze
Article

Abstract

In this article, we highlight recent Bipolar Collaborative Network data. We found that childhood-onset bipolar illness is common, often goes untreated for more than a decade, and carries a poor prognosis. During randomized studies of adjunctive medications in depression: 1) Venlafaxine showed higher switch rates than bupropion or sertraline; 2) Tranylcypromine was as well tolerated as lamotrigine; and 3) Modafinil was more effective than placebo. Finally, in treatment of overweight and obesity, topiramate and sibutramine showed equal efficacy but poor tolerability, and zonisamide data showed that it may be useful for mood and weight loss.

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References and Recommended Reading

  1. 1.
    Post RM, Leverich GS, Altshuler LL, et al.: An overview of recent findings of the Stanley Foundation Bipolar Network (Part I). Bipolar Disord 2003, 5:310–319.PubMedCrossRefGoogle Scholar
  2. 2.
    Post RM, Altshuler LL, Frye MS, et al.: An overview of recent findings of the Stanley Foundation Bipolar Network (SFBN) (Part II): focus on anticonvulsants. Aspects Affect 2005, 1:8–17.Google Scholar
  3. 3.
    Suppes T, Mintz J, McElroy SL, et al.: Mixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Network: a sex-specific phenomenon. Arch Gen Psychiatry 2005, 62:1089–1096. Two thirds of the women, but less than one half of the men, experienced dysphoric mania.PubMedCrossRefGoogle Scholar
  4. 4.
    Kraepelin E: Manic-Depressive Insanity and Paranoia. Edited by Robertson GM, Barclay RM (translator). Edinburgh, Scotland: E.S. Livingstone; 1921.Google Scholar
  5. 5.
    Frye MA, Altshuler LL, McElroy SL, et al.: Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder. Am J Psychiatry 2003, 160:883–889. Compared with the general population, women with bipolar disorder are seven times more likely to suffer from alcohol abuse; men are three times more likely. Women may be attempting to self-medicate their depressive and anxious symptoms.PubMedCrossRefGoogle Scholar
  6. 6.
    Vieta E: Bipolar mixed states and their treatment. Expert Rev Neurother 2005, 5:63–68.PubMedCrossRefGoogle Scholar
  7. 7.
    Rasgon NL, Altshuler LL, Fairbanks L, et al.: Reproductive function and risk for PCOS in women treated for bipolar disorder. Bipolar Disord 2005, 7:246–259. Women with bipolar illness have an increased incidence of menstrual abnormalities prior to treatment. Although valproate further increases these, we, in contrast to the STEP-BD Network, did not find valproate to be associated with hyperandrogenism or the PCOS.PubMedCrossRefGoogle Scholar
  8. 8.
    Kupka RW, Luckenbaugh DA, Post RM, et al.: Comparison of rapid-cycling and non-rapid-cycling bipolar disorder based on prospective mood ratings in 539 outpatients. Am J Psychiatry 2005, 162:1273–1280. Thirty-eight percent of patients continued to experience four or more episodes in a year of prospective follow-up despite treatment with an average of 4.5 classes of medications. Cycle frequency occurred on a continuum with no evidence of a clear distinction at the traditional cutoff of four episodes for rapid cycling.PubMedCrossRefGoogle Scholar
  9. 9.
    Post RM, Denicoff KD, Leverich GS, et al.: Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method. J Clin Psychiatry 2003, 64:680–690.PubMedCrossRefGoogle Scholar
  10. 10.
    Nolen WA, Luckenbaugh DA, Altshuler LL, et al.: Correlates of 1-year prospective outcome in bipolar disorder: results from the Stanley Foundation Bipolar Network. Am J Psychiatry 2004, 161:1447–1454.PubMedCrossRefGoogle Scholar
  11. 11.
    Judd LL, Akiskal HS, Schettler PJ, et al.: The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002, 59:530–537.PubMedCrossRefGoogle Scholar
  12. 12.
    Judd LL, Akiskal HS, Schettler PJ, et al.: A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003, 60:261–269.PubMedCrossRefGoogle Scholar
  13. 13.
    Denicoff KD, Leverich GS, Nolen WA, et al.: Validation of the prospective NIMH-Life-Chart Method (NIMH-LCM-p) for longitudinal assessment of bipolar illness. Psychol Med 2000, 30:1391–1397.PubMedCrossRefGoogle Scholar
  14. 14.
    Altshuler LL, Post RM, Black DO, et al.: Subsyndronal symptoms and functional impairment in patients wth bipolar disorder. J Clin Psychiatry 2006, In press.Google Scholar
  15. 15.
    Perlis RH, Miyahara S, Marangell LB, et al.: Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry 2004, 55:875–881.PubMedCrossRefGoogle Scholar
  16. 16.
    Leverich GS, Post RM: Course of bipolar illness after history of childhood trauma. Lancet 2006, 367:1040–1042. Childhood trauma appears to be a risk factor for early-onset bipolar disorder and subsequent suicidality. Traumatic life events interact with genetic-familial vulnerability in relation to early onset and a subsequent more severe course of bipolar disorder.PubMedCrossRefGoogle Scholar
  17. 17.
    Leverich GS, Post RM: The poor prognosis of childhoodonset bipolar disorder: the need for earlier recognition and treatment. J Pediatrics 2006, In press. Childhood-onset bipolar illness was and is more common than realized, was not pharmacologically treated for an average of 15 years after onset, and is associated with a more difficult course of illness assessed retrospectively and confirmed prospectively with clinician daily ratings.Google Scholar
  18. 18.
    Post RM, Kowatch RA: The health care crisis of childhood onset bipolar illness: some recommendations for its amelioration. J Clin Psychiatry 2006, 67:115–125.PubMedCrossRefGoogle Scholar
  19. 19.
    Wang PS, Berglund P, Olfson M, et al.: Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005, 62:603–613.PubMedCrossRefGoogle Scholar
  20. 20.
    Leverich GS, Altshuler LL, Frye MA, et al.: 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, 163:232–239. Venlafaxine (compared with bupropion and sertraline) was associated with a higher ratio of full switches into hypomania (≥ 7 days’ duration) or mania compared with brief and recurrent brief hypomania.PubMedCrossRefGoogle Scholar
  21. 21.
    Post RM, Altshuler LL, Leverich GS, et al.: Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry 2006, 189:124–131. Venlafaxine was more likely to be associated with switching into hypomania or mania than bupropion or sertraline. This was especially prominent in those with a history of rapid cycling in the year prior to study entry.PubMedCrossRefGoogle Scholar
  22. 22.
    Nierenberg AA, Ostacher MJ, Calabrese JR, et al.: Treatment-resistant bipolar depression: a STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotrigine, inositol, or risperidone. Am J Psychiatry 2006, 163:210 -216.PubMedCrossRefGoogle Scholar
  23. 23.
    Altshuler LL, Suppes T, Black DO, et al.: Lower switch rate in depressed patients with bipolar II than bipolar I disorder treated adjunctively with second-generation antidepressants. Am J Psychiatry 2006, 163:313–315.PubMedCrossRefGoogle Scholar
  24. 24.
    Benazzi F, Akiskal HS: Psychometric delineation of the most discriminant symptoms of depressive mixed states. Psychiatry Res 2006, 141:81–88.PubMedCrossRefGoogle Scholar
  25. 25.
    Nolen WA, Kupka RW, Hellemann G, et al.: Tranylcypromine versus lamotrigne as adjunctive treatment to a mood stabilizer in bipolar depression: an open randomized controlled study. Acta Psychiatr Scand 2006, In press.Google Scholar
  26. 26.
    Himmelhoch JM, Thase ME, Mallinger AG, Houck P: Tranylcypromine versus imipramine in anergic bipolar depression. Am J Psychiatry 1991, 148:910–916.PubMedGoogle Scholar
  27. 27.
    Calabrese JR, Keck PE, Jr, Macfadden W, et al.: A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry 2005, 162:1351–1360.PubMedCrossRefGoogle Scholar
  28. 28.
    Davis LL, Bartolucci A, Petty F: Divalproex in the treatment of bipolar depression: a placebo-controlled study. J Affect Disord 2005, 85:259–266.PubMedCrossRefGoogle Scholar
  29. 29.
    Zhang ZJ, Kang WH, Tan QR, et al.: Adjunctive herbal medicine with carbamazepine for bipolar disorders: a double-blind, randomized, placebo-controlled study. J Psychiatr Res 2005. [Epub ahead of print.]Google Scholar
  30. 30.
    Altshuler L, Suppes T, Black D, et al.: Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. Am J Psychiatry 2003, 160:1252–1262.PubMedCrossRefGoogle Scholar
  31. 31.
    Altshuler L, Kiriakos L, Calcagno J, et al.: The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression: a retrospective chart review. J Clin Psychiatry 2001, 62:612–616.PubMedCrossRefGoogle Scholar
  32. 32.
    Joffe RT, MacQueen GM, Marriott M, Young LT: One-year outcome with antidepressant—treatment of bipolar depression. Acta Psychiatr Scand 2005, 112:105–109.PubMedCrossRefGoogle Scholar
  33. 33.
    Ghaemi SN, El-Mallakh RS, Baldassano CF, et al.: A randomized clinical trial of efficacy and safety of long-term antidepressant use in bipolar disorder. Bipolar Disord 2006, 7:59.Google Scholar
  34. 34.
    Calabrese JR, Shelton MD, Rapport DJ, et al.: A 20-month, double-blind, maintenance trial of lithium versus divalproex in rapid-cycling bipolar disorder. Am J Psychiatry 2005, 162:2152–2161.PubMedCrossRefGoogle Scholar
  35. 35.
    Frye MA, Ketter TA, Leverich GS, et al.: The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study. J Clin Psychiatry 2000, 61:9–15.PubMedCrossRefGoogle Scholar
  36. 36.
    Judd LL, Akiskal HS: Depressive episodes and symptoms dominate the longitudinal course of bipolar disorder. Curr Psychiatry Rep 2003, 5:417–418.PubMedCrossRefGoogle Scholar
  37. 37.
    Judd LL, Paulus MJ, Schettler PJ, et al.: Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? Am J Psychiatry 2000, 157:1501–1504.PubMedCrossRefGoogle Scholar
  38. 38.
    Marangell LB: The importance of subsyndromal symptoms in bipolar disorder. J Clin Psychiatry 2004, 65:24–27.PubMedGoogle Scholar
  39. 39.
    McElroy SL, Frye MA, Suppes T, et al.: Correlates of overweight and obesity in 644 patients with bipolar disorder. J Clin Psychiatry 2002, 63:207–213.PubMedGoogle Scholar
  40. 40.
    McElroy SL, Suppes T, Keck PE, Jr, et al.: Open-label adjunctive zonisamide in the treatment of bipolar disorders: a prospective trial. J Clin Psychiatry 2005, 66:617–624.PubMedCrossRefGoogle Scholar
  41. 41.
    McElroy SL, Frye MA, Altshuler LL, et al.: A 24-week, randomized, controlled trial of adjunctive sibutramine versus topiramate in the treatment of weight gain in overweight or obese patients with bipolar disorders. Bipolar Disord 2006, In press. Both drugs showed parallel degrees of weight loss, but the dropout rate was high for both drugs; the dropout was greater earlier in the trial for topiramate and later in the trial for sibutramine.Google Scholar
  42. 42.
    Post RM, Speer AM, Leverich GS: Bipolar illness: Which critical treatment issues need studying? Clin Approaches Bipolar Disord 2003, 2:24–30.Google Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  • Robert M. Post
    • 1
    • 2
  • Lori L. Altshuler
  • Mark A. Frye
  • Trisha Suppes
  • Susan McElroy
  • Paul E. KeckJr
  • Gabriele S. Leverich
  • Ralph Kupka
  • Willem A. Nolen
  • Heinz Grunze
  1. 1.Penn State College of MedicineHersheyUSA
  2. 2.Bipolar Collaborative NetworkChevy ChaseUSA

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