title: Medical burden, body mass index and the outcome of psychosocial interventions for bipolar depression.
abstract: OBJECTIVE
  Individuals with bipolar disorder experience a disproportionately high incidence of medical co-morbidity and obesity. These health-related problems are a barrier to recovery from mood episodes and have been linked with unfavorable responses to pharmacological treatment. However, little is known about whether and how these characteristics affect responses to adjunctive psychotherapy.
  
  
  METHODS
  Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy plus pharmacotherapy with collaborative care (a three-session psycho-educational intervention) plus pharmacotherapy. We conducted a post-hoc analysis to evaluate whether medical burden and body mass index predicted and/or moderated the likelihood of recovery and time until recovery from a depressive episode among patients in the two treatments.
  
  
  RESULTS
  Participants who had medical co-morbidity and body mass index data constituted 199 of the 293 patients in the original Systematic Treatment Enhancement Program for Bipolar Disorder trial. Higher medical burden predicted a lower likelihood of recovery from depression in both treatment conditions (odds ratio = 0.89), but did not moderate responses to intensive psychotherapy vs collaborative care. Intensive psychotherapy yielded superior recovery rates for individuals of normal body mass index (odds ratio= 2.39) compared with collaborative care, but not among individuals who were overweight or obese.
  
  
  CONCLUSIONS
  Medical co-morbidity and body weight impacts symptom improvement and attention to this co-morbidity may inform the development of more personalized treatments for bipolar disorder.
authors.affiliation: University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Amy T
authors.initials: AT
authors.lastname: Peters
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Leah W
authors.initials: LW
authors.lastname: Shesler
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors.forename: Louisa
authors.initials: L
authors.lastname: Sylvia
authors.affiliation: Universidade Federal do Rio Grande do Sul, Porte Alegre, Brazil.
authors.forename: Pedro Vieira
authors.initials: PV
authors.lastname: da Silva Magalhaes
authors.affiliation: UCLA School of Medicine, Los Angeles, CA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.affiliation: Boston University, Boston, MA, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.affiliation: Deakin University, Melbourne, VIC, Australia University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors.forename: Darin D
authors.initials: DD
authors.lastname: Dougherty
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA tdeckersbach@partners.org.
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000628:therapy*; D015992:Body Mass Index; D003131:Combined Modality Therapy; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D016896:Treatment Outcome
keywords: Bipolar disorder; body mass index; medical burden; psychotherapy