Decreased activation and subsyndromal manic symptoms predict lower remission rates in bipolar depression

Marco Antonio Caldieraro, Samantha Walsh, Thilo Deckersbach, William V Bobo, Keming Gao, Terence A. Ketter, Richard C. Shelton, Noreen A. Reilly-Harrington, Mauricio Tohen, Joseph R. Calabrese, Michael E. Thase, James H. Kocsis, Louisa G. Sylvia, Andrew A. Nierenberg

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Objective: Activation encompasses energy and activity and is a central feature of bipolar disorder. However, the impact of activation on treatment response of bipolar depression requires further exploration. The aims of this study were to assess the association of decreased activation and sustained remission in bipolar depression and test for factors that could affect this association. Methods: We assessed participants with Diagnostic and Statistical Manual of Mental Disorders (4th ed) bipolar depression (n = 303) included in a comparative effectiveness study of lithium- and quetiapine-based treatments (the Bipolar CHOICE study). Activation was evaluated using items from the Bipolar Inventory of Symptoms Scale. The selection of these items was based on a dimension of energy and interest symptoms associated with poorer treatment response in major depression. Results: Decreased activation was associated with lower remission rates in the raw analyses and in a logistic regression model adjusted for baseline severity and subsyndromal manic symptoms (odds ratio = 0.899; p = 0.015). The manic features also predicted lower remission (odds ratio = 0.934; p < 0.001). Remission rates were similar in the two treatment groups. Conclusion: Decreased activation and subsyndromal manic symptoms predict lower remission rates in bipolar depression. Patients with these features may require specific treatment approaches, but new studies are necessary to identify treatments that could improve outcomes in this population.

Original languageEnglish (US)
JournalAustralian and New Zealand Journal of Psychiatry
DOIs
StateAccepted/In press - Nov 1 2017

Keywords

  • Bipolar disorder
  • depression
  • energy
  • treatment
  • treatment outcome

ASJC Scopus subject areas

  • Psychiatry and Mental health

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    Caldieraro, M. A., Walsh, S., Deckersbach, T., Bobo, W. V., Gao, K., Ketter, T. A., Shelton, R. C., Reilly-Harrington, N. A., Tohen, M., Calabrese, J. R., Thase, M. E., Kocsis, J. H., Sylvia, L. G., & Nierenberg, A. A. (Accepted/In press). Decreased activation and subsyndromal manic symptoms predict lower remission rates in bipolar depression. Australian and New Zealand Journal of Psychiatry. https://doi.org/10.1177/0004867417741982