title: Clinical correlates of sustained response to individual drugs used in naturalistic treatment of patients with bipolar disorder.
abstract: OBJECTIVE
  To report use and treatment success rates of medications for bipolar disorder as a function of patients' clinical characteristics.
  
  
  METHODS
  Outpatients with bipolar illness diagnosed by SCID were rated by research assistants on the NIMH-LCM and those who had an good response for at least 6months (much or very much improved on the CGI-BP) were considered responders (treatment "success"). Clinical characteristics associated with treatment response in the literature were examined for how often a drug was in a successful regimen when a given characteristic was either present or absent.
  
  
  RESULTS
  Lithium was less successful in those with histories of rapid cycling, substance abuse, or (surprisingly) a positive parental history of mood disorders. Valproate was less successful in those with ≥20 prior episodes. Lamotrigine (LTG) was less successful in those with a parental history of mood disorders or in BP-I compared to BP-II disorder. Antidepressants (ADs) had low success rates, especially in those with a history of anxiety disorders. Benzodiazepines had low success rates in those with child abuse, substance use, or ≥20 episodes. Atypical antipsychotics were less successful in the presence of rapid cycling, ≥20 prior episodes, or a greater number of poor prognosis factors.
  
  
  CONCLUSIONS
  Success rates reflect medications used in combination with an average of two other drugs during naturalistic treatment and thus should be considered exploratory. However, the low long-term success rates of drugs (even when used in combination with others) that occurred in the presence of many very common clinical characteristics of bipolar illness speak to the need for the development of alternative treatment strategies.
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, D.C., USA. Electronic address: robert.post@speakeasy.net.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Post
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, USA.
authors.forename: Gabriele S
authors.initials: GS
authors.lastname: Leverich
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Ralph
authors.initials: R
authors.lastname: Kupka
authors.affiliation: Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Lindner Center of HOPE, Mason, OH, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Keck
authors.affiliation: Lindner Center of HOPE, Mason, OH, USA; Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA.
authors.forename: Lori L
authors.initials: LL
authors.lastname: Altshuler
authors.affiliation: Department of Psychiatry, Mayo Clinic, Rochester, MI, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
authors.affiliation: Bipolar Collaborative Network, Bethesda, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rowe
authors.affiliation: Institute of Neuroscience, Academic Psychiatry, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA; V.A. Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Trisha
authors.initials: T
authors.lastname: Suppes
authors.affiliation: University Medical Center, University of Groningen, Groningen, the Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000235:genetics / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology; D009483:Neuropsychological Tests; D010045:Outpatients; D010290:Parents; D019966:Substance-Related Disorders / Q000523:psychology; D016896:Treatment Outcome; D014227:Triazines / Q000627:therapeutic use; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds; D014227:Triazines; D001569:Benzodiazepines; D014635:Valproic Acid; D000077213:Lamotrigine