American tertiary clinic-referred bipolar II disorder versus bipolar I disorder associated with hastened depressive recurrence

Bernardo Dell'Osso,Dennis Do,Po W Wang,Farnaz Hooshmand,Laura D Yuen,Shefali Miller,Saloni Shah,Terence A Ketter

doi:10.1186/s40345-017-0072-x

Abstract

BackgroundBipolar disorder (BD) is a chronic, frequently comorbid condition characterized by high rates of mood episode recurrence and suicidality. Little is known about prospective longitudinal characterization of BD type II (BD II) versus type I (BD I) in relation to time to depressive recurrence and recovery from major depressive episode. We therefore assessed times to depressive recurrence/recovery in tertiary clinic-referred BD II versus I patients.MethodsOutpatients referred to Stanford BD Clinic during 2000–2011 were assessed with Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation and with Clinical Monitoring Form during up to 2 years of naturalistic treatment. Prevalence and clinical correlates of bipolar subtype in recovered (euthymic ≥8 weeks) and depressed patients were assessed. Kaplan–Meier analyses assessed the relationships between bipolar subtype and longitudinal depressive severity, and Cox proportional hazard analyses assessed the potential mediators.ResultsBD II versus BD I was less common among 105 recovered (39.0 vs. 61.0%, p = 0.03) and more common among 153 depressed (61.4 vs. 38.6%, p = 0.006) patients. Among recovered patients, BD II was associated with 6/25 (24.0%) baseline unfavorable illness characteristics/mood symptoms/psychotropics and hastened depressive recurrence (p = 0.015). Among depressed patients, BD II was associated with 8/25 (33.0%) baseline unfavorable illness characteristics/mood symptoms/psychotropics, but only non-significantly associated with delayed depressive recovery.ConclusionsBD II versus BD I was significantly associated with current depression and hastened depressive recurrence, but only non-significantly associated with delayed depressive recovery. Research on bipolar subtype relationships with depressive recurrence/recovery is warranted to enhance clinical management of BD patients.

Highlights

Bipolar disorder (BD) is a chronic, frequently comorbid condition characterized by high rates of mood episode recurrence and suicidality
A Systematic Treatment Enhancement Program for BD (STEP-BD) report showed that, among the 58% of patients who recovered from a syndromal mood episode at enrollment, approximately half had mood episode recurrence within 2 years, with twice as many depressive compared to mood elevation recurrences (Perlis et al 2006)
Aiming at assessing potential differences between BD subtypes, in a previous cross-sectional study by our group, we found in an American tertiary clinic-referred setting that BD bipolar disorder type II (II), compared to BD I patients, had illness that was more severe in multiple ways but less severe in a few other ways (Dell’Osso et al 2015)

Summary

Introduction

Bipolar disorder (BD) is a chronic, frequently comorbid condition characterized by high rates of mood episode recurrence and suicidality. Little is known about prospective longitudinal characterization of BD type II (BD II) versus type I (BD I) in relation to time to depressive recurrence and recovery from major depressive episode. We assessed times to depressive recurrence/recovery in tertiary clinic-referred BD II versus I patients. In view of the phenomenological and biological heterogeneity of BDs and related clinical expressions, the recurrent episodic course has been traditionally considered the hallmark of the illness and the largest source of longitudinal burden (Angst and Sellaro 2000; Angst and Gamma 2008). Mood episode recurrences were found to occur in approximately half of bipolar patients within 2 years (Vazquez et al 2015), and in approximately. A Systematic Treatment Enhancement Program for BD (STEP-BD) report showed that, among the 58% of patients who recovered from a syndromal mood episode at enrollment, approximately half had mood episode recurrence within 2 years, with twice as many depressive compared to mood elevation recurrences (Perlis et al 2006)

Methods

Results

Conclusion