title: Mania: differential effects of previous depressive and manic episodes on response to treatment.
abstract: OBJECTIVE
  We compared effects of previous depressive or manic episodes on antimanic response.
  
  
  METHODS
  In-patients in a parallel-groups, double-blind comparison of lithium, divalproex or placebo for manic episodes had comprehensive evaluations of illness history. We used non-linear curve fitting of change in Manic Syndrome Score (MSS) of the Schedule for Affective Disorders and Schizophrenia (SADS) versus previous depressive or manic episodes to investigate their relationships to MSS improvement.
  
  
  RESULTS
  Response to lithium, but not to divalproex or placebo, worsened with increased depressive or manic episodes. More than 11 manic, or four depressive, episodes was associated with response to lithium that did not differ from placebo. Effects of previous depressive and manic episodes appeared independent, and could not be accounted for by increased rapid cycling or mixed states.
  
  
  CONCLUSIONS
  At least four previous depressive or 12 previous manic episodes are associated with reduced antimanic response to lithium.
authors.affiliation: University of Texas-Houston Medical School and Harris County Psychiatric Center, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Swann
authors.forename: C L
authors.initials: CL
authors.lastname: Bowden
authors.forename: J R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: S C
authors.initials: SC
authors.lastname: Dilsaver
authors.forename: D D
authors.initials: DD
authors.lastname: Morris
mesh_terms: D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003863:Depression; D004311:Double-Blind Method; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008297:Male; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D018692:Antimanic Agents; D014635:Valproic Acid; D008094:Lithium