title: Mood state at study entry as predictor of the polarity of relapse in bipolar disorder.
abstract: Of the placebo-controlled maintenance studies conducted in bipolar disorder, few have enrolled patients who present depressed. In fact, only lithium and lamotrigine have been studied over the long term with placebo-controlled designs in recently manic and recently depressed bipolar patients. Given the magnitude of the unmet medical need and the data suggesting that symptomatic patients with bipolar disorder spend the majority of their time depressed, this is unfortunate. Our review of the pre-lithium literature and more recent publications suggests that mood state at study entry predicts the polarity of relapse and the response to treatment. Accordingly, a need exists to enroll recently depressed patients in maintenance studies to elucidate the complete spectrum of efficacy of putative mood stabilizers and improve the long-term treatment of bipolar depression. Patients presenting depressed for a maintenance study tend to relapse into depression; those presenting manic, into hypomania/mania/mixed states. This is particularly true during the first several months of the randomized treatment. The polarity of the index episode tends to predict the polarity of relapse into a subsequent episode in a ratio of about 2:1 to 3:1. We conclude that putative mood stabilizers must be tested in recently manic and recently depressed patients to determine their spectrum of prophylactic efficacy.
authors.affiliation: Case University School of Medicine, University Hospitals of Cleveland, 11400 Euclid Avenue, Suite #200, Cleveland, OH 44106, USA. joseph.calabrese@uhhs.com
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.forename: Rif
authors.initials: R
authors.lastname: El-Mallakh
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.forename: Omar
authors.initials: O
authors.lastname: Elhaj
authors.forename: Prashant
authors.initials: P
authors.lastname: Gajwani
authors.forename: Ronald
authors.initials: R
authors.lastname: Pies
mesh_terms: D000339:Affect / Q000187:drug effects / Q000502:physiology*; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy; D004311:Double-Blind Method; D049673:History, 20th Century; D006801:Humans; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic / Q000266:history; D012008:Recurrence
chemical_list: D000928:Antidepressive Agents