Comparison of treatment outcome using two definitions of rapid cycling in subjects with bipolar II disorder.

Abstract

OBJECTIVES:

We examined differences in treatment outcome between Diagnostic and Statistical Manual Fourth Edition (DSM-IV)-defined rapid cycling and average lifetime-defined rapid cycling in subjects with bipolar II disorder. We hypothesized that, compared with the DSM-IV definition, the average lifetime definition of rapid cycling may better identify subjects with a history of more mood lability and a greater likelihood of hypomanic symptom induction during long-term treatment.

METHODS:

Subjects ≥18 years old with a bipolar II major depressive episode (n=129) were categorized into DSM-IV- and average lifetime-defined rapid cycling and prospectively treated with either venlafaxine or lithium monotherapy for 12 weeks. Responders (n=59) received continuation monotherapy for six additional months.

RESULTS:

These exploratory analyses found moderate agreement between the two rapid-cycling definitions (κ=0.56). The lifetime definition captured subjects with more chronic courses of bipolar II depression, whereas the DSM-IV definition captured subjects with more acute symptoms of hypomania. There was no difference between rapid-cycling definitions with respect to the response to acute venlafaxine or lithium monotherapy. However, the lifetime definition was slightly superior to the DSM-IV definition in identifying subjects who went on to experience hypomanic symptoms during continuation therapy.

CONCLUSIONS:

Although sample sizes were limited, the findings suggest that the lifetime definition of rapid cycling may identify individuals with a chronic rapid-cycling course and may also be slightly superior to the DSM-IV definition in identifying individuals with hypomania during relapse-prevention therapy. These findings are preliminary in nature and need replication in larger, prospective, bipolar II studies.

• Authors: Jay D Amsterdam, Lorenzo Lorenzo-Luaces, Robert J DeRubeis
• Journal: Bipolar disorders (Bipolar Disord) Vol. 19 Issue 1 Pg. 6-12 (02 2017) ISSN: 1399-5618 [Electronic] Denmark
• PMID: 28160351 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Antidepressive Agents
• Antimanic Agents

Topics

• Adult
• Affect (drug effects)
• Antidepressive Agents (administration & dosage)
• Antimanic Agents (administration & dosage)
• Bipolar Disorder (diagnosis, drug therapy, psychology)
• Diagnostic and Statistical Manual of Mental Disorders
• Female
• Humans
• Male
• Middle Aged
• Periodicity
• Prospective Studies
• Psychiatric Status Rating Scales
• Secondary Prevention (methods)
• Treatment Outcome