Bipolar Disorder Mood Research Articles

Striatal Functional Alterations Link to Distinct Symptomatology Across Mood States in Bipolar Disorder

BackgroundAs a central hub in cognitive and emotional brain circuits, the striatum is considered likely to be integrally involved in the psychopathology of bipolar disorder (BD). However, it remains unclear how alterations in striatal function contribute to distinct symptomatology of BD during different mood states. MethodsBehavioral assessment (i.e., emotional symptoms and cognitive performance) and neuroimaging data were collected from 125 participants comprising 31 (hypo)manic, 31 depressive, and 31 euthymic patients with BD, and 32 healthy control participants. We compared the functional connectivity (FC) of striatal subregions across BD mood states with healthy control participants and then used a multivariate data-driven approach to explore dimensional associations between striatal connectivity and behavioral performance. Finally, we compared the FC and behavioral composite scores, which reflect the individual weighted representation of the associations, among different mood states. ResultsPatients in all mood states exhibited increased FC between the bilateral ventral rostral putamen and ventrolateral thalamus. Bipolar (hypo)mania uniquely exhibited increased ventral rostral putamen connectivity and superior ventral striatum connectivity. One latent component was identified, whereby increased FCs of striatal subregions were associated with distinct psychopathological symptomatology (more manic symptoms, elevated positive mood, less depressive symptoms, and worse cognitive performance). Patients with bipolar (hypo)mania had the highest FC and behavioral composite scores while bipolar patients with depression had the lowest scores. ConclusionsOur data demonstrated both trait features of BD and state features specific to bipolar (hypo)mania. The findings underscored the fundamental role of the striatum in the pathophysiological processes underlying specific symptomatology across all mood states.

Are dysfunctional attitudes elevated and linked to mood in bipolar disorder? A systematic review and meta-analysis.

Dysfunctional attitudes (DA) are higher in depression; however, less is understood about their role in bipolar disorder (BD). This paper aimed to explore the presence of DA in BD in comparison to clinical and non-clinical groups. Also explored were the associations between DA and mood states of depression, mania or euthymia in BD. A systematic review and meta-analysis were conducted. A total of 47 articles were included in the systematic review of which 23 were included in the meta-analysis. The quality of each study was rated. The meta-analysis showed significantly higher DA in BD than healthy controls (d = .70). However, no difference was observed between BD and unipolar participants (d = -.16). When reviewing mood state within BD, a significant mean difference was found between DA scores for euthymic and depressed participants (d = -.71), with those who were depressed scoring higher. Three studies found that psychological therapies significantly reduce DA in BD (d = -.38). These findings imply not only that DA are both a characteristic of BD that is not as prevalent in healthy populations but also that a depressed mood state is associated with increased severity. This implies that DA could possibly go 'offline' when mood symptoms are not present. Psychological therapies appear to reduce DA in BD. Implications for future research as well as practice-based implications are expanded on in the discussion.

Bipolar Disorder and Gaming Disorder-Compatible or Incompatible Diagnoses?

Gaming Disorder (GD) is one of the latest additions in the psychiatric taxonomy, following its official inclusion in the latest revision of the International Classification of Diseases (ICD-11). This narrative review examines the rationale of an exclusion criterion for the diagnosis of GD, that of disordered gaming being limited exclusively during an episode of elevated mood in bipolar disorder. The history of the formulation of diagnostic criteria for the disorder and all relevant published studies are examined critically, and conclusions are drawn as to the potential validity and usability of the exclusion criterion. Suggestions are offered for future research to elucidate not only the relevance of the exclusion criterion but also the differential diagnosis of GD with pathological gambling (PG).

A preliminary investigation of the clinical and cognitive correlates of circulating vitamin D in bipolar disorder

The role that vitamin D plays in the cognitive and clinical characteristics of bipolar disorder (BD) is unclear. We examined differences in the levels and deficiency status of vitamin D in an Australian sample of BD patients compared to healthy controls; and determined the extent to which vitamin D is associated with clinical variables and cognitive function in the sample. 22 healthy controls and 55 stable outpatients with a diagnosis of BD and low-grade mood symptomatology provided a sample of blood and completed cognitive tests and clinical measures. Plasma concentrations of 25-hydroxyvitamin D (vitamin D) were assayed and used to segregate participants into subgroups with sufficient or deficient levels of vitamin D. Subgroups were then compared in terms of global cognition and a range of sociodemographic and clinical factors (number of past mood episodes, illness duration, seasonal mood pattern, mood symptom severity), while mean levels of vitamin D were compared between patients and controls. Although almost 27% of the current sample were vitamin D deficient, no significant differences in mean vitamin D levels or the prevalence of vitamin D deficiency were evident between BD patients and controls. Vitamin D was not associated with global cognition in either patients or controls, nor any of the clinical measures assessed in the study.In conclusion, we observed no difference in the vitamin D levels and deficiency status of an Australian sample of healthy individuals and BD patients with low grade mood symptomatology compared to controls. Clinical symptoms and global cognition also appear to be independent of vitamin D levels in BD.

Genome-wide Association Study in a Dish Provides New Insights Into an Old Medication

Understanding how lithium salts stabilize mood in bipolar disorder (BD) has been a quest of biological psychiatry for more than 50 years. While the impact of lithium on the inositol pathway through inhibition of GSK3B (glycogen synthase kinase-3b) and lithium’s promotion of neuroprotective factors like CREB (cAMP response element binding protein) are well established, we still do not know how these biochemical effects help modulate mood. Even less is known about how lithium interacts with the large and growing number of genetic risk factors for BD that have been identified through genome-wide association studies [GWASs; for review, see (1)].

Sexual dysfunction among males and females with bipolar disorder and healthy subjects: The burden of illness severity.

Sexual dysfunction has wide-ranging impacts on the person's functioning and quality of life, being associated with higher severity of psychiatric illnesses and poor therapeutic response. Given the paucity of data on this topic in bipolar disorder (BD), we investigated sexual functioning among males and females with BD and healthy controls (HCs) as well as whether illness severity markers and subthreshold mood symptoms were associated with sexual dysfunctions in BD patients. The study included 80 BD outpatients and 70 HCs. Sexual functioning was evaluated using the validated, gender-specific Changes in Sexual Functioning Questionnaire (CSFQ-14). BD patients had a significantly poorer sexual functioning than HCs (p< 0.00001). The odds of sexual dysfunction doubled given a one-unit increase in the number of suicide attempts (adjusted OR=2.01, 95% CI:1.23-3.55; p< 0.01) and increased by 60% for every additional hospitalization (p< 0.05). Greater illness duration was associated with arousal/orgasmic (p< 0.05) and overall sexual dysfunctions (p< 0.01). BD patients with more mixed or (hypo)manic episodes had a lower likelihood of libido loss and arousal/orgasmic disturbances (p< 0.01), respectively. Higher levels of subthreshold depressive symptoms increased by 20% the odds of sexual interest/frequency dysfunctions (p< 0.05), and up to 60% regarding orgasmic disturbances (p< 0.01). Sexual functioning may be a useful proxy of illness severity as well as a relevant dimension to more deeply characterize BD patients. Further studies are warranted to replicate our findings, to evaluate temporal associations between sexual dysfunctions and illness severity across the BD mood and treatment spectrums and to explore neurobiological underpinnings of these associations.

Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management

BackgroundIndividuals with bipolar disorder (BD) are increasingly turning to smartphone applications (apps) for health information and self-management support. While reviews have raised concerns regarding the effectiveness and safety of publicly available apps for BD, apps surveyed may not reflect what individuals with BD are using. The present study had two aims: first, to characterize the use of health apps to support mood and sleep amongst people with BD, and second, to evaluate the quality, safety and functionality of the most commonly used self-management apps.MethodsA web-based survey was conducted to explore which apps people with BD reported using to support self-management of mood and sleep. The characteristics of the most commonly nominated apps were described using a standardized framework, including their privacy policy, clinical foundations, and functionality.ResultsRespondents (n = 919) were 77.9% female with a mean age of 36.9 years. 41.6% of participants (n = 382) reported using a self-management app to support mood or sleep. 110 unique apps were nominated in relation to mood, and 104 unique apps nominated in relation to sleep; however, most apps were only mentioned once. The nine most frequently nominated apps related to mood and sleep were subject to further evaluation. All reviewed apps offered a privacy policy, however user control over data was limited and the complexity of privacy policies was high. Only one app was developed for BD populations. Half of reviewed apps had published peer-reviewed evidence to support their claims of efficacy, but little research was specific to BD.ConclusionFindings illustrate the potential of smartphone apps to increase the reach of psychosocial interventions amongst people with BD. Apps were largely created by commercial developers and designed for the general population, highlighting a gap in the development and dissemination of evidence-informed apps for BD. There may be risks in using generic health apps for BD self-management; clinicians should enquire about patients’ app use to foster conversations about their particular benefits and limitations.

Illness Chronology, Brain Morphology and Mixed Symptom Presentations in Older Age Bipolar Disorder: Emerging Findings from the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE –BD) Project

Roughly 25% of those with bipolar disorder (BD) are 60 years or older, and this proportion is likely to increase in tandem with changes in global demographics. Aging-related trajectories may also start in mid adulthood and lead to worse health outcomes such as cognitive decline and early mortality. The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project, a multi-national research initiative, pools archival research and clinical datasets to provide an evidence platform with potential to advance knowledge on older age BD (OABD). Key goals of investigators collaborating on the GAGE-BD project are to examine correlates of age of onset, understand BD mood symptom presentations, and set the stage for future investigations in aging-related changes in brain structure and functioning. In the first presentation, Dr. Lavin will describe an analysis of clinical correlates of late vs. early-onset BD. The majority of patients with BD have an onset before 40 years old. However, a significant number of individuals have onset of illness after age 40, commonly referred to as late-onset BD. This examination of a large international dataset sheds light on the association between the age of onset of BD symptoms and the distribution of risk factors and course of illness. Findings can yield important insights into the mechanisms involved in the evolution of BD across the life-span. In the second presentation, Dr. Blumberg will present on a new initiative to link neuroimaging findings with clinical data from the GAGE –BD sample. This talk will summarize procedures to harmonize aggregate data and how multi-national teams can collaborate to grow research capacity that is intended to better understand aging-related changes in brain structure and the relationship of the changes to demographic and clinical factors. Preliminary findings comparing older adults with BD to healthy participants on gray matter volume from structural magnetic resonance imaging (MRI) data, and white matter microstructure from diffusion-weighted MRI data, will be presented. In the third presentation, Dr. Eyler will discuss BD symptom severity mixity in OABD. The Diagnostic and Statistical Manual (DSM-5) includes a ‘with mixed features’ specifier that applies to a manic /hypomanic or to a depressive episode. Findings from the GAGE-BD samples suggested mixed features are relatively common in OABD, but do not suggest that mixity is associated with functional status. Future studies need to investigate whether mixed symptoms could contribute to BD neuroprogression in later life. Following the presentations, there will be discussion and ample opportunity for questions regarding emerging issues most relevant to OABD

Dynamics of data-driven microstates in bipolar disorder

Many of the existing models of mood in bipolar disorder can largely be divided into two camps, tracking mood as either a discrete or continuous variable. Both groups rely upon certain assumptions, with most considering only aggregate scores on clinical instruments. In this study, we propose a novel framework that combines elements from both discrete and continuous mood models, using a machine learning pipeline to detect subtle patterns across individuals. Latent factors are constructed from assessments at the item level, then clustered into groups referred to as microstates. Transitions between microstates are captured via a discrete-time Markov chain, allowing for characterization of mood's dynamic nature. Key findings include a factor mapping heavily onto irritability and aggression, as well as a hierarchical pattern of microstates within depression and mania. Validity of these results is confirmed by reproduction in an unseen data set from a separate subject cohort.

Decreased Functional Connectivity of Vermis-Ventral Prefrontal Cortex in Bipolar Disorder.

Objectives: To investigate changes in functional connectivity between the vermis and cerebral regions in the resting state among subjects with bipolar disorder (BD).Methods: Thirty participants with BD and 28 healthy controls (HC) underwent the resting state functional magnetic resonance imaging (fMRI). Resting-state functional connectivity (rsFC) of the anterior and posterior vermis was examined. For each participant, rsFC maps of the anterior and posterior vermis were computed and compared across the two groups.Results: rsFC between the whole vermis and ventral prefrontal cortex (VPFC) was significantly lower in the BD groups compared to the HC group, and rsFC between the anterior vermis and the middle cingulate cortex was likewise significantly decreased in the BD group.Limitations: 83.3% of the BD participants were taking medication at the time of the study. Our findings may in part be attributed to treatment differences because we did not examine the effects of medication on rsFC. Further, the mixed BD subtypes in our current study may have confounding effects influencing the results.Conclusions: These rsFC differences of vermis-VPFC between groups may contribute to the BD mood regulation.

Reward mechanism of depressive episodes in bipolar disorder: Enhanced theta power in feedback-related negativity

IntroductionThis study aimed to explore the reward-related neural mechanism in patients with depressive mood in bipolar disorder (BD) using event-related potentials. It remains unknown whether or not different neurobiological markers underlying depression symptoms in BD depression and major depression disorder (MDD). Methods24 patients with BD depression and 20 healthy controls were included. Participants underwent evaluation with the Temporal Experience of Pleasure Scale (TEPS), followed by the classical gambling paradigm, while undergoing 64-channel electroencephalography. The waveform of feedback-related negativity (FRN) was extracted from the 250–350 ms time-window after participants received feedback regarding loss or gain. Event-related potential datasets were obtained using time-frequency analysis. Results(1) The TEPS scores of the patients were significantly lower than those of the controls [t(42) = 5.16, p < 0.01]. (2) The event of loss elicited a deeper FRN in patients than that in controls [t(42) = 2.19, p < 0.05], while no difference was observed in the event of gains (t(42) = 1.12, p > 0.05). (3) Theta power rooted in FRN in patients was significantly higher in loss than in gain [F(1,42) = 30.32, p < 0.01]. (4) Analysis of Variance (ANOVA) illustrated the interaction effect of theta power in gain/loss between two groups [F(1,42) = 3.59, p = 0.06]. LimitationOur study did not analyze the effect of different drugs which might affect our results. ConclusionThe enhanced reflection of negative feedback was consistent with the negative bias, impulse control impairment, and emotional dysregulation observed in the bipolar disorder spectrum. We suggested that the extreme theta power generated from the anterior cingulate gyrus (ACC) might be the main component of abnormal FRN.

Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte and Monocyte-to-Lymphocyte Ratio in Bipolar Disorder.

Background: Several inflammatory hypotheses have been suggested to explain the etiopathogenesis of bipolar disorder (BD) and its different phases. Neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios have been proposed as potential peripheral biomarkers of mood episodes. Methods: We recruited 294 patients affected by BD, of which 143 were experiencing a (hypo)manic episode and 151 were in a depressive phase. A blood sample was drawn to perform a complete blood count. NLR, PLR, and MLR were subsequently calculated. A t-test was performed to evaluate differences in blood cell counts between depressed and (hypo)manic patients and a regression model was then computed. Results: Mean values of neutrophils, platelets, mean platelet volume, NLR, PLR, and MLR were significantly higher in (hypo)manic than depressed individuals. Logistic regression showed that PLR may represent an independent predictor of (hypo)mania. Conclusions: Altered inflammatory indexes, particularly PLR, may explain the onset and recurrence of (hypo)manic episodes in patients with BD. As inflammatory ratios represent economical and accessible markers of inflammation, further studies should be implemented to better elucidate their role as peripheral biomarkers of BD mood episodes.

A narrative review of cross-sectional and prospective associations between self-schemas and bipolar disorder.

The role of self-concept in bipolar disorder (BD) has not been well understood. The present review utilizes the notion of self-schema and interrogates existing research concerning evidence for cross-sectional and prospective associations between four schema-like constructs (i.e. trait self-esteem, dysfunctional beliefs concerning contingent self-worth, early maladaptive schemas and implicit self-esteem) and various facets of BD. Existing findings demonstrate various types of involvement of self-schemas in BD. Of particular clinical relevance, the present review suggests that low trait self-esteem and dysfunctional beliefs concerning contingent self-worth are risk factors for ongoing BD symptoms and mood episodes. The present review also yields important yet unaddressed questions with respect to the evaluative content of self-schemas associated with the hypo/manic phase of BD.

Psychiatric aspect of most common used cardiological drugs

Introduction: The count of psychiatric patients is growing. The same trend it is observed among cardiovascular diseases and metabolic like diabetes. Many people take drugs which may affect on mental state. On the one hand that drugs could have pleotropic mechanism of action which are beginning to use in treatment of psychiatry. The other hand is showed undiscovered field of impact on brain working. Methods and Aim: Shown the psychiatric aspect, like side effects and unusual use, of the most used cardiological drugs. To do this, research of articles was done with the help of deta bases such as PubMed and Google Scholar.Results: The most used cardiological drugs are beta blockers, calcium canal blockers, ACE inhibtors, ARBs, nitrats, cilostazol, amiodarone and clonidine In this article it was shown current known about those drugs like mechanism of action and a report of psychiatric clinical trials. Beta-blockers are the most commonly used group of cardiological drugs as the one that significantly affects mental health. Their therapeutic importance has been noted in diseases such as: PTSD or stage fright. It was also long believed that they could make depression worse, but the latest research strongly contradicts this. A positive effect in the treatment of depression can also be obtained by usage of inhibitors of the RAA. Calcium channel blockers are another group of cardiac drugs that are important in the regulation of mood in bipolar disorder. To sum up, a large proportion of cardiac drugs can influence the flow of psychiatric diseases, and the use of them may be clinically desirable in patients with both - cardiac and psychiatric problems.

Altered frontal cortex functioning in emotion regulation and hopelessness in bipolar disorder.

Emotion regulation difficulties precipitate and exacerbate acute mood symptoms in individuals with bipolar disorder (BD), and contribute to suicidal behavior. However, few studies have examined regional brain responses in explicit emotion regulation during acute BD mood states, or hopelessness, a major suicide risk factor. We assessed brain responses during explicit emotion regulation, and their relationship with hopelessness, in acutely symptomatic and euthymic individuals with BD. Functional MRI data were obtained from individuals with BD who were either in acute negative (BD-A; n=24) or euthymic (BD-E; n=24) mood states, and from healthy volunteers (HV; n=55), while participants performed a paradigm that instructed them to downregulate their responses to fearful (EmReg-Fear) and happy (EmReg-Happy) facial stimuli. Emotion regulation-related differences in brain responses during negative and euthymic BD states, as well as their associations with negative affective symptoms (hopelessness and depression), were examined. Decreased responses were observed in ventral and dorsal frontal regions, including medial orbitofrontal (mOFC) and dorsal anterior cingulate cortices, during EmReg-Fear across symptomatic and euthymic states in participants with BD relative to HVs. The lowest responses were observed in the BD-A group. Across BD participants, negative associations were observed between mOFC responses and hopelessness, particularly due to loss of motivation. Differences were not significant during EmReg-Happy. Lesser emotion regulation-related ventral and dorsal frontal engagement in BD could represent a trait abnormality that worsens during acute negative states. The reduced mOFC engagement in BD during explicit regulation of negative emotions may contribute to hopelessness particularly in the context of diminished motivation.

Ecological momentary assessment of the relationships between social activity and mood in bipolar disorder

Abstract Bipolar disorder is associated with significant impairment in social functioning. The temporal sequence of day-to-day interrelationships between mood and social activity is not well understood, yet could inform targets for cognitive behavioral interventions. The present study examined associations between mood and social activity in real-time through ecological momentary assessments administered via smartphones. In all, 41 outpatients with bipolar disorder were provided with smartphones for 11 weeks and completed twice-daily surveys about affective symptoms and social activity. We assessed the ways in which symptoms at baseline are related to the frequency and type of social interactions in the EMA period. Furthermore, we analyzed the associations between social activity, concurrent and lagged self-ratings of mood state, and momentary positive and negative affect ratings. Participants’ mean (and SD) age was 46.9 (11.8) years, with 53.7% being women. Participants spent an average of 42% of their sampled time alone. The average time spent alone was lower for hypo/manic symptoms (36%) than for depressive symptoms (45%) with euthymic mood intermediate between the two (40%). Positive affect was higher and negative affect (e.g., sadness, anger) was lower during concurrent social interactions. Positive affect was lower during time spent alone, but negative affect did not differ from time spent alone or from other interactions. Lagged models indicated a stronger association between prior social activity and subsequent mood than the converse. Social activity tracked mood polarity over several months. More support was found for social activity influencing mood state compared to the converse. Monitoring social activity may facilitate targeted cognitive behavioral interventions in bipolar disorder.

Forecasting Mood in Bipolar Disorder From Smartphone Self-assessments: Hierarchical Bayesian Approach.

BackgroundBipolar disorder is a prevalent mental health condition that is imposing significant burden on society. Accurate forecasting of symptom scores can be used to improve disease monitoring, enable early intervention, and eventually help prevent costly hospitalizations. Although several studies have examined the use of smartphone data to detect mood, only few studies deal with forecasting mood for one or more days.ObjectiveThis study aimed to examine the feasibility of forecasting daily subjective mood scores based on daily self-assessments collected from patients with bipolar disorder via a smartphone-based system in a randomized clinical trial.MethodsWe applied hierarchical Bayesian regression models, a multi-task learning method, to account for individual differences and forecast mood for up to seven days based on 15,975 smartphone self-assessments from 84 patients with bipolar disorder participating in a randomized clinical trial. We reported the results of two time-series cross-validation 1-day forecast experiments corresponding to two different real-world scenarios and compared the outcomes with commonly used baseline methods. We then applied the best model to evaluate a 7-day forecast.ResultsThe best performing model used a history of 4 days of self-assessment to predict future mood scores with historical mood being the most important predictor variable. The proposed hierarchical Bayesian regression model outperformed pooled and separate models in a 1-day forecast time-series cross-validation experiment and achieved the predicted metrics, R2=0.51 and root mean squared error of 0.32, for mood scores on a scale of −3 to 3. When increasing the forecast horizon, forecast errors also increased and the forecast regressed toward the mean of data distribution.ConclusionsOur proposed method can forecast mood for several days with low error compared with common baseline methods. The applicability of a mood forecast in the clinical treatment of bipolar disorder has also been discussed.

Assessment and treatment of sleep problems in bipolar disorder-A guide for psychologists and clinically focused review.

Sleep problems are highly prevalent in bipolar disorder (BD) and constitute an important therapeutic focus in this population: They are highly impairing and distressing, are an area of subjective importance to consumers, and likely play a role in predicting/triggering mood episodes. The aim of this review is to orient psychologists and psychotherapists to current research relevant to their clinical practice with people with BD, including (a) the prevalence and presentation of sleep problems, (b) the impacts and correlates of impaired sleep, and (c) the relationship between sleep problems and mood symptoms (including the predictive/triggering role of sleep in BD mood relapses). Detailed recommendations for assessment and cognitive-behavioural intervention strategies for use in BD are described. It will be concluded that although some sleep problems and comorbidities require interdisciplinary collaboration, a range of evidence-informed strategies can be effectively and appropriately applied by clinical psychologists and psychotherapists.

Clinical validation of the BDSx scale with bipolar disorder outpatients

PurposeThe BDSx (Bipolar Disorder Symptom Scale) is a brief self-report instrument designed for repeated measurement of bipolar disorder (BD) symptoms over time. Previous research indicates that the BDSx measures two depression (cognitive and somatic symptoms) and two hypo/mania factors (affrontive symptoms and elation/loss of insight). The purpose of this study was to validate BDSx responses relative to diagnoses of BD mood episodes. MethodsSixty BD outpatients attending routine clinic appointments completed the BDSx, the Hamilton Rating Scale for Depression, the Altman Self-Rating Mania Scale, and the Satisfaction with Life Scale. Blind to scale responses by patients, a clinic psychiatrist determined if patients were currently symptomatic. ResultsBDSx depression and hypo/mania subscales showed good construct validity vis-à-vis clinical diagnoses, and concurrent/discriminant validity with other self-report scales. And though not designed as a screening measure, sensitivity for the depression subscale is high at 88% (6+, 76% specificity), yet lower at 57% for the hypo/mania subscale (5+, 90% specificity). ConclusionsThe results of this study indicate that BDSx responses distinguish patients experiencing depressive and hypo/manic mood episodes. Findings support the psychometric properties of the Hebrew version of this scale. The BDSx enables those with bipolar disorder to monitor their symptoms, gauge symptom variability, and identify factors that proceed and sustain BD symptoms over time.

The effect of atorvastatin on cognition and mood in bipolar disorder and unipolar depression patients: A secondary analysis of a randomized controlled trial

ObjectivesStatins have recently been linked to having effects on cognition and mood in mood disorders, though results are mixed. In this paper, we use data from a recent randomized controlled trial (RCT) to examine the effect of statins on cognition and mood in patients with Bipolar Disorder (BD) and Major Depressive Disorder (MDD). MethodsThis is a secondary analysis of a randomized, double-blind, placebo-controlled clinical trial (n = 60) originally designed to examine the effect of atorvastatin (n = 27) versus placebo (n = 33) for lithium-induced diabetes insipidus in BD and MDD patients who were using lithium. For this analysis, the primary outcome was global cognition Z-score at 12-weeks adjusted for baseline. The secondary cognition outcomes were (1) Screen for Cognitive Impairment in Psychiatry (SCIP), and (2) executive function Z-score. The primary mood outcome (secondary outcome of this analysis) was depression relapse during 12-week follow-up (Mongomery Asberg Depression Rating Scale (MADRS) ≥10). The secondary mood outcomes were (1) relapse rate into a manic episode, and (2) relapse rate into any mood episode. ResultsAfter 12 weeks follow-up, atorvastatin and placebo groups did not differ in terms of global cognition Z-score (β = −0.009287 (−0.1698,0.1512), p-value = 0.91). Similarly, composite Z-scores for SCIP and executive functions did not differ significantly. Depression relapse during 12-week follow-up was not significantly different between the groups (χ2 (1) = 0.148, p-value = 0.70). Similarly, there was no difference between groups regarding relapse into mania. ConclusionIn BD and MDD patients with lithium-induced nephrogenic diabetes insipidus randomized to atorvastatin or placebo, we found no significant differences in cognition and mood outcomes at 12-week follow-up.