Current irritability associated with hastened depressive recurrence and delayed depressive recovery in bipolar disorder.

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

doi:10.1186/s40345-016-0056-2

Laura D Yuen, Farnaz Hooshmand + Show 5 more

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https://doi.org/10.1186/s40345-016-0056-2

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Abstract

BackgroundCurrent irritability is associated with greater retrospective and current bipolar disorder (BD) illness severity; less is known about prospective longitudinal implications of current irritability. We examined relationships between current irritability and depressive recurrence and recovery in BD.MethodsOutpatients referred to the Stanford BD Clinic during 2000–2011 were assessed with the Systematic Treatment Enhancement Program for BD (STEP-BD) Affective Disorders Evaluation at baseline, and with the Clinical Monitoring Form during follow-up during up to 2 years of naturalistic treatment. Prevalence and clinical correlates of any current irritability in depressed and recovered (euthymic ≥8 weeks) BD patients were assessed. Kaplan–Meier analyses (Log-Rank tests) assessed relationships between current irritability and longitudinal depressive severity, with Cox Proportional Hazard analyses assessing potential mediators.ResultsRecovered BD outpatients with vs. without current irritability had significantly higher rates of 13/19 (68.4 %) other baseline unfavorable illness characteristics/current mood symptoms and hastened depressive recurrence (Log-Rank p = 0.020), driven by lifetime history of anxiety disorder and prior year rapid cycling, and attenuated by history of psychosis. Depressed BD outpatients with vs. without current irritability had significantly higher rates of 7/19 (36.8 %) other unfavorable illness characteristics/current mood symptoms and delayed depressive recovery (Log-Rank p = 0.034), NOT mediated by any assessed parameter.LimitationsLimited generalizability beyond our predominately white, female, educated, insured American BD specialty clinic sample.ConclusionsCurrent irritability was associated with hastened depressive recurrence and delayed depressive recovery in BD. Treatment studies targeting irritability may yield strategies to mitigate increased longitudinal depressive burden.

Highlights

Current irritability is associated with greater retrospective and current bipolar disorder (BD) illness severity; less is known about prospective longitudinal implications of current irritability
Current irritability was associated with hastened depressive recurrence and delayed depressive recovery in BD
Current irritability was inversely associated with history of psychosis (31.6 vs. 55.2 %, χ2 = 5.5, df = 1, p = 0.025) and prior psychiatric hospitalization (31.6 vs. 55.2 %, χ2 = 5.5, df = 1, p = 0.025), both of these relationships were mediated by the association of bipolar II subtype with current irritability

Summary

Introduction

Current irritability is associated with greater retrospective and current bipolar disorder (BD) illness severity; less is known about prospective longitudinal implications of current irritability. Up to one-half of BD patients have mood episode recurrence within 1 year of recovery (Solomon et al 1995), commonly with severe consequences, including higher rates of non-response, social morbidity, and impaired functioning (Berk et al 2011; Lish et al 1994; Rosa et al 2012). Mood elevation episodes define BD, bipolar depression is more pervasive (Judd et al 2002, 2003), and has been associated with functional impairment (Goldberg and Harrow 2011; Gyulai et al 2008) and suicidality (Dilsaver et al. Yuen et al Int J Bipolar Disord (2016) 4:15. Bipolar depression negatively impacts BD illness course; with illness severity worsening with recurrent episodes, independent of treatment (Maj et al 1992)

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