Current Psychiatry Reports

, Volume 9, Issue 6, pp 497–503 | Cite as

STEP-BD and bipolar depression: What have we learned?



This article summarizes recent findings from the STEP-BD project pertaining to bipolar depression treatment. Highlighted are four papers that report, in turn, a large, randomized controlled trial of adjunctive antidepressants; a large, randomized controlled trial of adjunctive psychosocial therapies (cognitive-behavioral therapy, interpersonal social rhythms therapy, and family-focused therapy); a small, randomized controlled trial contrasting lamotrigine, risperidone, and inositol as add-on therapies for refractory bipolar depression; and a naturalistic study of the risks of relapse during preventive therapy. The STEP-BD results highlight the challenge of treating bipolar depression to remission, illustrate the value of adjunctive psychotherapies, and point to new directions for research.

References and Recommended Reading

  1. 1.
    Lieberman JA, Stroup TS, McEvoy JP, et al.: Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005, 353:1209–1223.PubMedCrossRefGoogle Scholar
  2. 2.
    Rush AJ, Trivedi MH, Wisniewski SR, et al.: Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006, 163:1905–1917PubMedCrossRefGoogle Scholar
  3. 3.
    Sachs GS, Thase ME, Otto MW, et al.: Rationale, design, and methods of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Biol Psychiatry 2003, 53:1028–1042.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    Thase ME, Sachs GS: Bipolar depression: pharmacotherapy and related therapeutic strategies. Biol Psychiatry 2000, 48:558–572.PubMedCrossRefGoogle Scholar
  6. 6.
    Lavori PW, Rush AJ, Wisniewski SR, et al.: Strengthening clinical effectiveness trials: equipoise-stratified randomization. Biol Psychiatry 2001, 50:792–801.PubMedCrossRefGoogle Scholar
  7. 7.
    Sachs GS, Printz DJ, Kahn DA, et al.: The Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder 2000. Postgrad Med 2000, April:1–104.Google Scholar
  8. 8.
    Miklowitz DJ, Otto MW, Frank E, et al.: Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry 2007, 64:419–426.PubMedCrossRefGoogle Scholar
  9. 9.
    Miklowitz DJ, Otto MW, Frank E, et al.: Intensive psychosocial intervention enhances functioning in patients with bipolar depression: results from a 9-month randomized controlled trial. Am J Psychiatry 2007, 164:1340–1347.PubMedCrossRefGoogle Scholar
  10. 10.
    Chengappa KN, Levine J, Gershon S, et al.: Inositol as an add-on treatment for bipolar depression. Bipolar Disord 2000, 2:47–55.PubMedCrossRefGoogle Scholar
  11. 11.
    Nolen WA, Kupka RW, Hellemann G, et al.: Tranylcypromine vs. lamotrigine in the treatment of refractory bipolar depression: a failed but clinically useful study. Acta Psychiatr Scand 2007, 115:360–365.PubMedCrossRefGoogle Scholar
  12. 12.
    Tohen M, Vieta E, Calabrese J, et al.: Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry 2003, 60:1079–1088.PubMedCrossRefGoogle Scholar
  13. 13.
    Calabrese JR, Keck PE, 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
  14. 14.
    Thase ME, MacFadden W, Weisler RH, et al.: Efficacy of quetiapine monotherapy in bipolar I and II depression: a double-blind, placebo-controlled study (The BOLDER II study). J Clin Psychopharmacol 2006, 26:600–609.PubMedCrossRefGoogle Scholar
  15. 15.
    Perlis RH, Ostacher MJ, Patel JK, et al.: Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry 2006, 163:217–224.PubMedCrossRefGoogle Scholar
  16. 16.
    Goldberg JF, Perlis RH, Ghaemi SN, et al.: Adjunctive antidepressant use and symptomatic recovery among bipolar depressed patients with concomitant manic symptoms: findings from the STEP-BD. Am J Psychiatry 2007, 164:1348–1355.PubMedCrossRefGoogle Scholar
  17. 17.
    Sachs GS, Nierenberg AA, Calabrese JR, et al.: Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med 2007, 356:1711–1722.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.University of Pennsylvania School of MedicinePhiladelphiaUSA

Personalised recommendations