title: Differential clinical characteristics, medication usage, and treatment response of bipolar disorder in the US versus The Netherlands and Germany.
abstract: Increased early-onset bipolar illness was seen in the US compared with the Netherlands and Germany (abbreviated here as Europe), but other clinical characteristics, medication use, and treatment response have not been systematically explored. Outpatients with bipolar disorder were treated naturalistically and followed prospectively at four sites in the US and three in Europe. Data and clinical characteristics were collected from patient questionnaires, and medication usage and good-to-excellent response to treatment for at least 6 months ascertained from daily clinician ratings on the National Institutes of Mental Health-Life Chart Method. Almost all clinical characteristics earlier associated with a poor treatment response were more prevalent in the US than in Europe, including early onset, environmental adversity, rapid cycling, more than 20 prior episodes, comorbid anxiety and substance abuse disorders, and a positive parental history for an affective disorder. Lithium was used more frequently in Europe than in the US and had a higher rate of success, whereas valproate was used more in the US, with a trend toward higher success in Europe. Antidepressants were used more in the US, but had extremely low success rates. Many other agents were deployed differently on the two continents, but success rates were consistently lower in the US than in Europe. In conclusion, clinical characteristics and patterns of medication usage and effectiveness differed markedly in the two continents suggesting the need for uncovering explanations and considering the two populations as heterogeneous in the future pharmacological studies.
authors.affiliation: Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA. robert.post@speakeasy.ne
authors.forename: Robert M
authors.initials: RM
authors.lastname: Post
authors.forename: Gabriele S
authors.initials: GS
authors.lastname: Leverich
authors.forename: Lori L
authors.initials: LL
authors.lastname: Altshuler
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
authors.forename: Trisha
authors.initials: T
authors.lastname: Suppes
authors.forename: Paul E
authors.initials: PE
authors.lastname: Keck
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
authors.forename: Ralph
authors.initials: R
authors.lastname: Kupka
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
authors.forename: Joerg
authors.initials: J
authors.lastname: Walden
authors.forename: Mike
authors.initials: M
authors.lastname: Rowe
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000453:epidemiology; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D018450:Disease Progression; D005858:Germany; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D009426:Netherlands; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines