Abstract
BackgroundAlthough mood stabilizers such as lithium (LIT), valproate (VAL), and lamotrigine (LMT) appear to be efficacious treatments for bipolar disorder (BD) in research settings, the long-term response to these mood stabilizers in clinical practice is highly variable among individuals. Thus, the present study examined the characteristics associated with good or insufficient responses to long-term treatment with LIT, VAL, or LMT for BD.MethodsThis study retrospectively analyzed the medical records of patients who visited an outpatient clinic with a diagnosis of BD I or II. Data from patients who were treated with one of three mood stabilizing medications (LIT, VAL, or LMT) for more than 6 months were selected, and the long-term treatment responses were evaluated using the Alda scale. For the purposes of this study, two response categories were formed: insufficient response (ISR), including non-response or poor response (Alda total score ≤ 6), and good response (GR; Alda total score ≥ 7).ResultsOf the 645 patients included in the present study, 172 were prescribed LIT, 320 were prescribed VAL, and 153 were prescribed LMT for at least 6 months. A binary logistic regression analysis revealed that a diagnosis of BD II (odds ratio [OR], 8.868; 95% confidence interval [CI], 1.123–70.046; p = 0.038), comorbid alcohol/substance use disorder (OR, 4.238; 95% CI, 1.154–15.566; p = 0.030), and a history of mixed episodes (OR, 4.363; 95% CI, 1.191–15.985; p = 0.026) were significant predictors of LIT-ISR. Additionally, a depressive-predominant polarity significantly predicted LMT-GR (OR, 8.586; 95% CI, 2.767–26.644; p < 0.001).ConclusionThe present findings demonstrated that patients with a diagnosis of BD II, a comorbid alcohol/substance problem, or a history of mixed episodes were not likely to respond to LIT treatment. Additionally, LMT might be a better treatment choice for patients with a depressive-predominant polarity.
Highlights
Bipolar disorder (BD) is a severe and common chronic illness associated with high risks of relapse and recurrence as well as increased morbidity and mortality [1, 2]
Predictors for long-term response to mood stabilizers regression analysis revealed that a diagnosis of bipolar disorder (BD) II, comorbid alcohol/substance use disorder (OR, 4.238; 95% CI, 1.154–15.566; p = 0.030), and a history of mixed episodes (OR, 4.363; 95% CI, 1.191–15.985; p = 0.026) were significant predictors of LIT-insufficient response (ISR)
The present findings demonstrated that patients with a diagnosis of BD II, a comorbid alcohol/substance problem, or a history of mixed episodes were not likely to respond to LIT treatment
Summary
Bipolar disorder (BD) is a severe and common chronic illness associated with high risks of relapse and recurrence as well as increased morbidity and mortality [1, 2]. BD patients with a higher number of previous episodes tend to experience higher rates of disability, greater impairments in cognitive and interpersonal functioning, and a poorer overall quality of life [5, 6] These findings suggest that long-term maintenance treatments are of paramount importance to prevent subsequent episodes, reduce residual symptoms, and restore functioning and quality of life [7, 8]. The prediction of long-term mood stabilization effect to specific medications could substantially reduce the risk of a breakthrough or recurrence Mood stabilizers such as lithium (LIT), valproate (VAL), and lamotrigine (LMT) appear to be efficacious treatments for bipolar disorder (BD) in research settings, the longterm response to these mood stabilizers in clinical practice is highly variable among individuals. The present study examined the characteristics associated with good or insufficient responses to long-term treatment with LIT, VAL, or LMT for BD
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