The Prospective Course of Rapid-Cycling Bipolar Disorder: Findings From the STEP-BD

Schneck, Christopher D.; Miklowitz, David J.; Miyahara, Sachiko; Araga, Mako; Wisniewski, Stephen R.; Gyulai, Laszlo; Allen, Michael; Thase, Michael E.; Sachs, Gary S.

doi:10.1176/appi.ajp.2007.05081484

Cited by 158 publications

(130 citation statements)

References 19 publications

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“…6 However, controversy still exists, with one study having reported later age at onset for RC 28 and other studies reporting no difference in age at onset between RC and NRC. 7,29,30 Another finding of the present study that is consistent with the literature is the higher number of suicide attempts and the higher proportion of suicide attempters in the RC group. 4,6,13,14 This might be explained by the usually longer duration of disease associated with RC, which would be related to the earlier age at onset discussed above.…”

Section: Discussionsupporting

confidence: 91%

“…[37][38][39] Our study corroborates the notion that hypothyroidism and hyperthyroidism are not associated with RC. Confirming the findings of numerous previous studies, 6,7,13,17,20,38 we observed a higher rate of antidepressant use in the RC group. Some authors have found that the likelihood of cycling increases linearly with antidepressant use, with patients taking antidepressants being over three times more likely to have RC than patients who do not use antidepressants.…”

Section: Discussionsupporting

confidence: 91%

“…3 The estimated 12-month prevalence of RCBD ranges from 9 to 32%, whereas the lifetime prevalence of RCBD ranges from 26 to 43%. [4][5][6][7][8] Many studies have investigated the differences between BD patients with and without RC. In general, RCBD has been associated with worse disease outcome 9,10 and more severe disability.…”

Section: Introductionmentioning

confidence: 99%

“…7,11,12 More specifically, many factors have been described to be associated with RC, such as female gender, 5,13 earlier age at onset, 6,12 increased risk for suicide, 13,14 predominance of depression, 15,16 hypothyroidism, 6,17 bipolar type II disorder, 8,18,19 and higher rates of antidepressants use. 7,20 However, some of these associations are still controversial, and many studies have been criticized regarding aspects such as lack of a uniform definition of RC and use of heterogeneous samples. Thus, more studies are needed to clarify which factors are associated with the presence of RC in BD.…”

Section: Introductionmentioning

confidence: 99%

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Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Gigante

Barenboim

Dias

et al. 2016

Rev. Bras. Psiquiatr.

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Objective: Rapid cycling (RC) is a feature of bipolar disorder (BD) that has been associated with worse outcome and more severe disability. Our goal was to investigate the association of demographic and clinical factors with RC. Methods: We compared RC and non-rapid cycling (NRC) BD patients from the Brazilian Research Network in Bipolar Disorder (BRN-BD) regarding age at onset of BD; total number of episodes; previous number of manic, depressive, mixed, and hypomanic episodes; polarity of the first episode; gender; number of suicide attempts; number of lifetime hospitalizations and lifetime history of at least one hospitalization; family history of mood disorder; clinical comorbidities such as hypothyroidism, hyperthyroidism, seizures; and current use of medications such as lithium, anticonvulsants, antipsychotics, and antidepressants. Results: We studied 577 patients and found that 100 (17.3%) met the criteria for RC in the year before the investigation. RC patients had earlier age at onset, longer duration of disease, more lifetime depressive and manic episodes, higher number of suicide attempts, and higher rate antidepressant use. Conclusion: The presence of RC in the previous year was associated with specific clinical characteristics closely related to worse outcome in the course of BD.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Gigante

Barenboim

Dias

et al. 2016

Rev. Bras. Psiquiatr.

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“…23 Another vital clinical observation examines the prospective course of rapid-cycling in BD. 24 Using a convenience sample of enrollees (n = 1742), mood episodes were prospectively observed. Among the 1742, 32% had experienced rapid cycling in the year preceding the STEP-BD study, and 32% dropped out before 1 year of treatment was completed.…”

Section: Observations On Bipolar Depression From the Standard Care Pamentioning

confidence: 99%

Advancing Bipolar Disorder: Key Lessons from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

2010

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W La Revue canadienne de psychiatrie, vol 55, no 3, mars 2010 136Objective: To review the overall clinical research findings from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), the world's largest study of BD.Methods: STEP-BD was conducted from 1998 to 2005, enrolling participants (n = 4361) across 22 clinical sites in the United States. Each individual was followed for up to 2 years in naturalistic practice with blinded research assessments, while subgroups participated in randomized controlled trials (RCTs) for bipolar depression. The naturalistic database was used to examine the course of BD, comorbidity with other psychiatric disorders, and suicidality. Relevant studies in English, published from January 1, 1994, to May 31, 2009, were identified using computerized searches of electronic databases (PubMed, PsycINFO, and Cochrane Register of Clinical Trials), inspection of bibliographies, and review of other major reports. Results:One large RCT involving the addition of either paroxetine or bupropion to mood stabilizers in acute depression found neither more effective than placebo in achieving sustained recovery (8 weeks of euthymia). A second large RCT found intensive psychosocial interventions superior to a brief psychosocial intervention as an adjunct to medication in acute depression. A third small RCT found minimal effects of lamotrigine, risperidone, or inositol in refractory depression. Recovery was difficult to achieve, with subsyndromal symptoms or full relapse very common. Anxiety disorders and smoking in particular were treatable conditions that adversely affected the course of BD.Conclusions: STEP-BD yielded numerous clinical and systems observations that provide fresh direction for research and treatment of BD, including setting new benchmarks for outcome and demonstrating the viability of large BD networks.Can J Psychiatry. 2010;55(3):136-143. Highlights· STEP-BD was the largest BD research program ever conducted, and included data from 3 major RCTs and findings from many observational studies. · Few treatments were successful in bipolar depression, with psychosocial interventions combined with mood stabilizers the most positive. · Comorbidity of BD with substance abuse and smoking were common and adversely affected clinical outcome, while comorbidity with adult attention-deficit hyperactivity disorder was modest.

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National Patterns in Antidepressant Medication Treatment

Olfson

Marcus

2009

Arch Gen Psychiatry

674

462

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The Prospective Course of Rapid-Cycling Bipolar Disorder: Findings From the STEP-BD

Cited by 158 publications

References 19 publications

Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Advancing Bipolar Disorder: Key Lessons from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

National Patterns in Antidepressant Medication Treatment

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