Early improvement of specific symptoms predicts subsequent recovery in bipolar depression

Reanalysis of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) data

Jin Mizushima, Hiroyuki Uchida, Mitsuhiro Tada, Takefumi Suzuki, Masaru Mimura, Shintaro Nio

Research output: Contribution to journalArticle

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Abstract

Objective: The aim of this post hoc analysis was to evaluate which specific depressive items could predict subsequent durable recovery in patients with bipolar depression. Methods: 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. Results: 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). Conclusions: These findings imply that focusing on individual symptoms is important in bipolar depression, rather than relying solely on a summed score in rating scales. Trial Registration: The original STEP-BD dataset is registered on ClinicalTrials.gov (identifier: NCT00012558).

Original languageEnglish
Pages (from-to)e146-e151
JournalJournal of Clinical Psychiatry
Volume78
Issue number2
DOIs
Publication statusPublished - 2017 Feb 1

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Bipolar Disorder
Therapeutics
Placebos
Depression
Self Concept
Diagnostic and Statistical Manual of Mental Disorders
Pharmaceutical Preparations
Antidepressive Agents
Logistic Models
Regression Analysis
Population

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Early improvement of specific symptoms predicts subsequent recovery in bipolar depression : Reanalysis of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) data. / Mizushima, Jin; Uchida, Hiroyuki; Tada, Mitsuhiro; Suzuki, Takefumi; Mimura, Masaru; Nio, Shintaro.

In: Journal of Clinical Psychiatry, Vol. 78, No. 2, 01.02.2017, p. e146-e151.

Research output: Contribution to journalArticle

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