title: Longitudinal follow-up of bipolar disorder in women with premenstrual exacerbation: findings from STEP-BD.
abstract: OBJECTIVE
  The impact of hormonal fluctuation during the menstrual cycle on the course of bipolar disorder is poorly understood. The authors determined the course of illness and time to relapse of bipolar disorder in prospectively followed women with premenstrual exacerbation.
  
  
  METHODS
  Participants were 293 premenopause-age women with bipolar disorder who were followed prospectively for 1 year as part of the Systematic Treatment Enhancement Program for Bipolar Disorder. Frequency of mood episodes was compared between 191 women with premenstrual exacerbation (65.2%) and 102 women without. Among 129 women who were in recovered status at baseline, time to relapse was compared between 66 women with premenstrual exacerbation (51.2%) and 63 without.
  
  
  RESULTS
  During follow-up, the group with premenstrual exacerbation had more episodes (primarily depressive) than did the group without, but they were not more likely to meet criteria for rapid cycling during this period. In contrast, they were more likely to report rapid cycling retrospectively. Women with premenstrual exacerbation had a shorter time to relapse and were at greater risk for relapse, but this association was not significant after adjustment for retrospectively reported rapid cycling. Women with premenstrual exacerbation had more depressive and mood elevation symptoms overall.
  
  
  CONCLUSIONS
  Women with bipolar disorder and premenstrual exacerbation have a worse course of illness, a shorter time to relapse, and greater symptom severity, but they are not more likely to meet criteria for rapid cycling. Premenstrual exacerbation may be a clinical marker predicting a more symptomatic and relapse-prone phenotype in reproductive-age women with bipolar disorder.
authors.affiliation: Bipolar Clinic and Research Program, Massachusetts General Hospital, Boston, USA. rdgdias@gmail.com
authors.forename: Rodrigo S
authors.initials: RS
authors.lastname: Dias
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
authors.forename: Cibele
authors.initials: C
authors.lastname: Russo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Debbio
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Gary S
authors.initials: GS
authors.lastname: Sachs
authors.forename: Hadine
authors.initials: H
authors.lastname: Joffe
mesh_terms: D000328:Adult; D000339:Affect; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D018020:Lithium Compounds / Q000627:therapeutic use; D011293:Premenstrual Syndrome / Q000150:complications* / Q000523:psychology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents; D018020:Lithium Compounds; D017367:Selective Serotonin Reuptake Inhibitors