Category: Bipolar Disorders
Although bipolar disorder is defined on the basis of manic episodes, depressive episodes are present for most people with this disorder and are a major determinant of impairment. In the past 10 years, considerable debate has emerged regarding the effectiveness of antidepressants for bipolar depression. One previous study has indicated that the presence of a manic episode before depression is related to worse response to antidepressants, but the findings were limited by the small number of participants. To examine this effect in a larger sample, we employed data from a large, multi-site study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. 250 Participants who met DSM-IV criteria for Bipolar I Disorder, Bipolar II Disorder, Bipolar Disorder NOS, or Cyclothymic Disorder were recruited during an episode of major depression, and they were randomly assigned to receive Paroxetine, Bupropion or placebo as adjuncts to mood stabilizers.
The Affective Disorder Evaluation (ADE) form, administered at study entry, provided a diagnosis of bipolar disorder, as well as current and previous episode status. At each follow up visit, participants were assessed using the Clinical Monitoring Form, a standardized, validated semi-structured interview that provides depression (SUM-D) and mania (SUM-ME) severity scores.
We conducted a binary regression model to examine the main and interactive effects of prior mania and medication on recovery (SUM-D and SUM-ME scores < 3).
Neither medication condition nor prior mania, or their interaction, were significant predictors.
Contrary to previous findings, presence of manic episode preceding a depressive episode in patients with bipolar disorder did not significantly predict antidepressant response. The current findings are in agreement with other research indicating that the course of mania and depression are separable.
University of California - Berkeley