An overview of recent findings of the Stanley Foundation Bipolar Network (Part I).
OBJECTIVE
Selected recent findings of the Stanley Foundation Bipolar Network are briefly reviewed and their clinical implications discussed.


RESULTS
Daily prospective ratings on the NIMH-LCM indicate a high degree of residual depressive morbidity (three times that of hypomania or mania) despite active psychopharmacological treatment with a variety of modalities including mood stabilizers, antidepressants, and benzodiazepines, as well as antipsychotics as necessary. The rates of switching into brief to full hypomania or mania during the use of antidepressants is described, and new data suggesting the potential utility of continuing antidepressants in the small group of patients showing an initial acute and persistent response is noted. Bipolar patients with a history of major environmental adversities in childhood have a more severe course of illness and an increased incidence of suicide attempts compared with those without. Preliminary open data suggest useful antidepressant effects of the atypical antipsychotic quetiapine, while a double-blind randomized controlled study failed to show efficacy of omega-3 fatty acids (6 g of eicosapentaenoic acid compared with placebo for 4 months) in the treatment of either acute depression or rapid cycling. The high prevalence of overweight and increased incidence of antithyroid antibodies in patients with bipolar illness is highlighted.


CONCLUSIONS
Together, these findings suggest a very high degree of comorbidity and treatment resistance in outpatients with bipolar illness treated in academic settings and the need to develop not only new treatment approaches, but also much earlier illness recognition, diagnosis, and intervention in an attempt to reverse or prevent this illness burden.
Post
Robert M
RM
Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD 20892-1272, USA. robert.post@nih.gov
Leverich
Gabriele S
GS
Altshuler
Lori L
LL
Frye
Mark A
MA
Suppes
Trisha M
TM
Keck
Paul E
PE
McElroy
Susan L
SL
Kupka
Ralph
R
Nolen
Willem A
WA
Grunze
Heinz
H
Walden
Jorg
J
D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D004347:Drug Interactions; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005582:Foundations; D006801:Humans; D007255:Information Services / Q000458:organization & administration*; D015201:Meta-Analysis as Topic; D012307:Risk Factors; D013959:Thyroid Diseases / Q000150:complications
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D015525:Fatty Acids, Omega-3