Rapid-cycling bipolar disorder: effects of long-term treatments

• Published in: Acta psychiatrica Scandinavica 2003-07, Vol.108 (1), p.4-14
• Main Authors: Tondo, L., Hennen, J., Baldessarini, R. J.
• Format: Article
• Language: English
• Subjects: anticonvulsants; Biological and medical sciences; Bipolar Disorder - classification; Bipolar Disorder - drug therapy; bipolar disorders; carbamazepine; Humans; lamotrigine; lithium; Long-Term Care - statistics & numerical data; Medical sciences; meta-analysis; morbidity; Neuropharmacology; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; rapid-cycling; topiramate; Treatment Outcome; valproate
• ISSN: 0001-690X; 1600-0447
• DOI: 10.1034/j.1600-0447.2003.00126.x

Objective: To compare responses to long‐term treatment of rapid‐cycling (RC) vs. non‐RC bipolar disorder patients and assess relative effectiveness of specific agents in RC patients. Method: Studies identified by literature searching were analyzed for effects of RC status and treatment‐type on clinical outcome (recurrence or non‐improvement per exposure‐time), using random‐effects methods to estimate pooled rates and their 95% CI for quantitative meta‐analytic modeling. Results: Data were obtained from 16 reports with 25 trial‐arms involving 1856 (905 RC and 951 non‐RC) patients treated with carbamazepine, lamotrigine, lithium, topiramate, or valproate, alone or with other agents over an average of 47.5 months (7347 total patient‐years). Estimated RC prevalence was 15.4%. Crude rates (%/month) of recurrence (2.31/1.20) and clinical non‐improvement (1.93/0.49) averaged 2.9‐fold greater in RC vs. non‐RC subjects. The pooled RC/non‐RC risk ratio (RR) for inferior treatment‐response (in 13 direct comparisons) was 1.40 (CI 1.26—1.56; P