Clinical factors associated with lithium response in bipolar disorders

Abstract

Only three factors previously identified as predictors of lithium response significantly differentiated the response groups identified in our sample. Interestingly, these factors have all been found to co-occur more often than expected by chance, and it can be hypothesized that they may represent a shared underlying factor or dimension. Further prospective studies of predictors and the performance of the Alda scale are recommended.

Polygenic scores for major depressive disorder and depressive symptoms predict response to lithium in patients with bipolar disorder

“…Our findings could form part of a genetic explanation for the previously described clinical observations in relation to mania, depression and lithium response in BD 6,7,[27][28][29][30][31][32][33][34] and supports the notion that lithium responsiveness could be associated with a 'core' bipolar phenotype in the Kraepelinian form of manic depression 34,44 . Such a concept is further supported by our previous finding of an inverse association of lithium response and schizophrenia PGS in BD 16 .…”

“…Another study described an episodic illness pattern of 'mania-depression-interval' as a predictor for good response, whereas a 'depression-mania-interval' predicted poorer outcomes 31 . Inter-episode residual mood symptoms, as opposed to full remission 6,7,32 , a rapid cycling pattern 31,32 , and a history of mixed episodes 33,34 have also been described as predictors of poor response.…”

Distinct lithium-induced gene expression effects in lymphoblastoid cell lines from patients with bipolar disorder

“…This goes along with the increasing body of evidence suggesting a key role of pharmacogenetics in the response to lithium (Pisanu et al, 2016a). Accordingly, different, more homogeneous phenotypes have been identified within patients regarding their likelihood of showing an adequate response to lithium treatment (responders vs. nonresponders) (Geoffroy et al, 2017; Oedegaard et al, 2016; Scott et al, 2017; Sportiche et al, 2016), and the genetic basis of lithium responsiveness has been consistently shown by several studies (Alda, 2015; Alda et al, 2005; Grof et al, 2009; Grof et al, 2002; Hou et al, 2016). This is also supported by in vitro studies performed with LCLs, in which lithium has been shown to exert specific effects based on the donor’s treatment responsiveness (Hunsberger et al, 2015; Milanesi et al, 2015; Squassina et al, 2013).…”

Obesity, mixed, and bipolar features in major depression: Should we identify the usual suspects or also look for covert mediators?

“…This propensity relies on the presence of a series of clinical features (such as impulsivity, emotional reactivity or lability, racing thoughts or psychomotor agitation) that clinicians may want to target preferentially with antipsychotic agents and that are more likely to ‘respond’ to these drugs. This might also be related to the widely held belief (although not consistently supported in the literature) that lithium might be less effective in patients with mixed episodes . Interestingly, Petri et al study provided multivariate analyses that highlight independent contributions of both mixed features (ie, depressive mixed state according to DSM‐5) and antipsychotic agents in the determinants of obesity on patients with MDE.…”

“…This might also be related to the widely held belief (although not consistently supported in the literature) that lithium might be less effective in patients with mixed episodes. 2 Interestingly, Petri et al study provided multivariate analyses that highlight independent contributions of both mixed features (ie, depressive mixed state according to DSM-5) and antipsychotic agents in the determinants of obesity on patients with MDE. This means that obesity in patients with MDE is, as expected, multifactorial with the potential contribution of adverse effects of antipsychotic agents that are not exclusively responsible.…”