title: Affective instability and the course of bipolar depression: results from the STEP-BD randomised controlled trial of psychosocial treatment.
abstract: BACKGROUND
  Little is known about predictors of recovery from bipolar depression.
  
  
  OBJECTIVE
  We investigated affective instability (a pattern of frequent and large mood shifts over time) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychosocial treatment for acute depression.
  
  
  METHODS
  A total of 252 out-patients with DSM-IV bipolar I or II disorder and who were depressed enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and were randomised to one of three types of intensive psychotherapy for depression (n= 141) or a brief psychoeducational intervention (n= 111). All analyses were by intention-to-treat.
  
  
  RESULTS
  Degree of instability of symptoms of depression and mania predicted a lower likelihood of recovery and longer time until recovery, independent of the concurrent effects of symptom severity. Affective instability did not moderate the effects of psychosocial treatment on recovery from depression.
  
  
  CONCLUSIONS
  Affective instability may be a clinically relevant characteristic that influences the course of bipolar depression.
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Stange
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Pedro Vieira
authors.initials: PV
authors.lastname: da Silva Magalhães
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Yim
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Darin D
authors.initials: DD
authors.lastname: Dougherty
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: Jonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA tdeckersbach@partners.org.
authors.forename: Thilo
authors.initials: T
authors.lastname: Deckersbach
mesh_terms: D000328:Adult; D000339:Affect; D001714:Bipolar Disorder / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D016896:Treatment Outcome; D055815:Young Adult