title: Who will benefit from antidepressants in the acute treatment of bipolar depression? A reanalysis of the STEP-BD study by Sachs et al. 2007, using Q-learning.
abstract: BACKGROUND
  There is substantial uncertainty regarding the efficacy of antidepressants in the treatment of bipolar disorders.
  
  
  METHODS
  Traditional randomized controlled trials and statistical methods are not designed to discover if, when, and to whom an intervention should be applied; thus, other methodological approaches are needed that allow for the practice of personalized, evidence-based medicine with patients with bipolar depression.
  
  
  RESULTS
  Dynamic treatment regimes operationalize clinical decision-making as a sequence of decision rules, one per stage of clinical intervention, that map patient information to a recommended treatment. Using data from the acute depression randomized care (RAD) pathway of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, we estimate an optimal dynamic treatment regime via Q-learning.
  
  
  CONCLUSIONS
  The estimated optimal treatment regime presents some evidence that patients in the RAD pathway of STEP-BD who experienced a (hypo)manic episode before the depressive episode may do better to forgo adding an antidepressant to a mandatory mood stabilizer.
authors.affiliation: Department of Statistics, North Carolina State University, 2311 Stinson Drive, Raleigh, 27695 USA.
authors.forename: Fan
authors.initials: F
authors.lastname: Wu
authors.affiliation: Department of Statistics, North Carolina State University, 2311 Stinson Drive, Raleigh, 27695 USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Laber
authors.affiliation: Quintiles, 4820 Emperor Blvd, Durham, 27703 USA.
authors.forename: Ilya A
authors.initials: IA
authors.lastname: Lipkovich
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden,, Fetscherstraße 74,, 01307 Dresden Germany.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Severus
keywords: Antidepressant; Bipolar disorders; Dynamic treatment regimes; Q-learning
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