title: Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).
abstract: BACKGROUND
  The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy.
  
  
  METHODS
  Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments.
  
  
  RESULTS
  Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10-20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes.
  
  
  CONCLUSIONS
  Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.
authors: University of Illinois at Chicago,Chicago, IL,USA.
authors: A
authors: A
authors: Peters
authors: Massachusetts General Hospital,Boston, MA,USA.
authors: L G
authors: LG
authors: Sylvia
authors: Universidade Federal de Rio Grande de Sul,Porte Alegre,Brazil.
authors: P V da Silva
authors: PV
authors: Magalhães
authors: UCLA School of Medicine,Los Angeles, CA,USA.
authors: D J
authors: DJ
authors: Miklowitz
authors: University of Pittsburgh,Pittsburgh, PA,USA.
authors: E
authors: E
authors: Frank
authors: Boston University,Boston, MA,USA.
authors: M W
authors: MW
authors: Otto
authors: Massachusetts General Hospital,Boston, MA,USA.
authors: N S
authors: NS
authors: Hansen
authors: Massachusetts General Hospital,Boston, MA,USA.
authors: D D
authors: DD
authors: Dougherty
authors: Deakin University,Melbourne,Australia.
authors: M
authors: M
authors: Berk
authors: Massachusetts General Hospital,Boston, MA,USA.
authors: A A
authors: AA
authors: Nierenberg
authors: Massachusetts General Hospital,Boston, MA,USA.
authors: T
authors: T
authors: Deckersbach
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000379:methods* / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult