title: Early Improvement of Specific Symptoms Predicts Subsequent Recovery in Bipolar Depression: Reanalysis of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) Data.
abstract: The aim of this post hoc analysis was to evaluate which specific depressive items could predict subsequent durable recovery in patients with bipolar depression.
  
  
  
  The study population was at least 18 years old and met DSM-IV criteria for a major depressive episode associated with either bipolar I or II disorder. The data were derived from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), in which patients with bipolar depression were randomly assigned to treatment for acute depression with a mood stabilizer plus an adjunctive antidepressant drug or placebo. The primary and secondary outcomes were durable recovery (ie, 8 consecutive weeks of euthymia) and treatment-emergent affective switch (ie, transition to mania or hypomania), respectively. Binary logistic regression analysis was performed to identify specific symptoms whose improvement during the first 2 weeks predicted those outcomes; the score change of each individual symptom in the continuous symptom subscales for depression (SUM-D) from week 0 to week 2 was used as an independent variable.
  
  
  
  In the evaluable 188 participants who took placebo and active drugs, the improvement in loss of self-esteem (P = .037) or loss of energy (P = .040) at week 2 was significantly associated with higher chances of subsequent durable recovery. For participants taking active drugs (n = 91), solely the improvement in loss of energy at week 2 was significantly associated with subsequent durable recovery (P = .027). There was a significant association between the improvement of psychomotor retardation at week 2 and subsequent affective switch (P = .008).
  
  
  
  These findings imply that focusing on individual symptoms is important in bipolar depression, rather than relying solely on a summed score in rating scales.
  
  
  
  The original STEP-BD dataset is registered on ClinicalTrials.gov (identifier: NCT00012558).
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.|Department of Psychiatry, Tachikawa Hospital, Tokyo, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Mizushima
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.|Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uchida
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.|Department of Psychiatry, Saiseikai Central Hospital, Tokyo, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Tada
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.|Department of Psychiatry, Inokashira Hospital, Tokyo, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Mimura
authors.affiliation: Department of Psychiatry, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073 Japan. shin@dd.catv.ne.jp.|Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.|Department of Psychiatry, Saiseikai Central Hospital, Tokyo, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Nio
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001143:Arousal / Q000187:drug effects; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D011379:Prognosis; D012649:Self Concept; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents