To analyze new and reviewed findings to evaluate relations between treatment response and latency from onset of bipolar disorder (BD) to the start of mood-stabilizer prophylaxis.
Method:
We analyzed our own new data and added findings from research reports identified by computerized searching.
Results:
We found 11 relevant studies, involving 1485 adult patients diagnosed primarily with BD. Reported latency to prophylaxis averaged 9.6 years (SD 1.3), and follow-up in treatment averaged 5.4 years (SD 3.1). Greater illness intensity and shorter treatment latency were closely associated, resulting in a greater apparent reduction in morbidity with earlier treatment. However, this finding was not sustained after correction for pretreatment morbidity, and treatment latency did not predict morbidity during treatment. Therefore, assessments based on improvement with treatment, or without correction for pretreatment morbidity, can be misleading.
Conclusions:
Available evidence does not support the proposal that delayed prophylaxis may limit response to prophylactic treatment in BD and related disorders.
MajMPirozziRMaglianoLBartoliL.Long-term outcome of lithium prophylaxis in bipolar disorder: A 5-year prospective study of 402 patients at a lithium clinic. Am J Psychiatry1998;155:30–5.
2.
BaldessariniRJTondoLHennenJFlorisG.Latency and episodes before treatment: Response to lithium maintenance in bipolar I and II disorders. Bipolar Disord1999;2:91–7.
3.
BaethgeCSmolkaMGruschkaPBerghöferASchlattmannPBauerM, and others. Does prophylaxis-delay in BDD influence outcome? Results from a long-term study of 147 patients. Acta Psychiatr Scand2003;107:260–7.
4.
HartongEGTMMolemanPHoogduinCALBroekmanTGNolenWA, the LitCar Group. Prophylactic efficacy of lithium vs carbamazepine in treatment naïve bipolar patients. J Clin Psychiatry2003;64:144–51.
5.
PostRWeissSRB. Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. Am J Psychiatry1992;149:999–1010.
6.
PostRMWeissSRB. Neurobiological models of recurrence in mood disorder. In: CharneyDSNestlerEJBunneyBS, editors. Neurobiology of mental illness. New York: Oxford University Press; 1999. p 365–84.
7.
ManjiHKMooreGJChenG.Clinical and preclinical evidence for the neurotrophic effects of mood stabilizers: Implications for the pathophysiology and treatment of manic-depressive illness. Biol Psychiatry2000;48:740–54.
8.
FranchiniLZanardiRSmeraldiEGasperiniM.Early onset of lithium prophylaxis as a predictor of good long-term outcome. Eur Arch Psychiatry Clin Neurosci1999;249:227–30.
9.
SerettiALattuadaEFranchiniLSmeraldiE.Melancholic features and response to lithium prophylaxis in mood disorders. Depress Anxiety2000:11:73–9.
10.
KraepelinE.Psychiatrie: Ein kurzes Lehrbuch für Studierende und Ärzte, achte, überarbeitete Auflage. Leipzig: von Barth Verlag; 1920. (Also: BarclayRMRobertsonGM, editors. Kraepelin E. Manic-depressive insanity and paranoia. Edinburgh: E and S Livingstone; 1921.
11.
GoodwinFKJamisonKR. Manic-depressive illness. New York: Oxford University Press; 1990. p 134–6.
12.
GoodwinFKGhaemiSN. Understanding manic-depressive illness. Arch Gen Psychiatry1998;55:23–5.
13.
GoddardGVMcIntyreDCLeechCK. A permanent change in brain function resulting from daily electrical stimulation. Exp Neurol1969;25:295–330.
14.
DrevetsWC. Neuroimaging studies of mood disorders. Biol Psychiatry2000;48:813–28.
15.
ManjiHKMooreGJRajkowskaGChenG.Neuroplasticity and cellular resilience in mood disorders. Mol Psychiatry2000;5:578–93.
16.
MooreGJBebchukJMWildsIBChenGManjiHK. Lithium-induced increase in human brain grey matter. Lancet2000;356:1241–2.
17.
TondoLIsacssonGBaldessariniRJ. Suicide in BDD: Risk and prevention. CNS Drugs2003;17:491–511.
18.
TohenMZarateCAJrHennenJKaurkhalsaH-MStrakowskiSMGebre-MedhinP, and others. The McLean-Harvard First-Episode Mania Study: Prediction of recovery and first recurrence. Am J Psychiatry2003. Forthcoming.
19.
JuddLJAkiskalHSSchettlerPJCoryellWEndicottJMaserJD, and others. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar disorder. Arch Gen Psychiatry2003;60:261–9.
20.
DeshauerDGrofEAldaMGrofP.Patterns of DST positivity in remitted affective disorders. Biol Psychiatry1999;45:1023–9.
21.
SAS CorpStatview-5. Cary (NC): SAS Corp; March 1998.
22.
BaastrupPCSchouM.Lithium as a prophylactic agent. Arch Gen Psychiatry1967;16:162–72.
23.
BoumanTKKampenJG Niemandsverdriet-VanOrmelJSlooffC.The effectiveness of lithium in bipolar and unipolar depressions and schizoaffective disorders. J Affect Disord1986;11:275–80.
24.
MajMPirozziRMaglianoL.Late non-response to lithium pophylaxis in bipoar patients: Prevalence and predictors. J Affect Disord1996;39:39–42.
25.
KusalicMEngelsmann. Predictors of lithium treatment responsiveness in bipolar patients. Neuropsychbiology1998;37:146–9.
26.
KulharaPBasuDMattooSKSharanPChopraR.Lithium-prophylaxis of recurrent bipolar affective disorder: Long-term outcome and its psychosocial correlates. J Affect Disord1999;54:87–96.
27.
Garcia-LópezAEzquiagaENievesPRodríguez-SalvanésE.Factores predictores de requesta al litio en pacientes bipolares en seguimiento a largo plazo. Actas Esp Psiquiatr2001:29:327–32.
28.
GoldbergJFErnstCL. Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder. J Clin Psychiatry2002;63:985–91.
29.
BaldessariniRJTondoLHennenJ.Treatment latency and previous episodes: Relationship to pretreatment morbidity and response to maintenance treatment in bipolar I and II disorders. Bipolar Disord2003;5:1–11.
30.
BaethgeCGruschkaPBerghöferABauerMMüller-OerlinghausenBBschorT, and others. Prophylaxis of schizoaffective disorder with lithium or carbamazepine: Outcome after long-term follow-up. J Affect Disord2003. Forthcoming.
31.
BaethgeCGruschkaPSmolkaMNBerghöferABschorTMüller-OerlinghausenB, and others. Effectiveness and outcome predictors of long-term lithium prophylaxis in unipolar major depressive disorder. J Psychiatry Neurosci2003. Forthcoming.
32.
BrattiIMBaldessariniRJBaethgeCTondoL.Pretreatment episode count and response to lithium treatment in manic-depressive illness. Harv Rev Psychiatry2003. Forthcoming.
FaeddaGLBaldessariniRJSuppesTTondoLBeckerILipschitzD.Pediatric-onset bipolar disorder: A neglected clinical and public health problem. Harv Rev Psychiatry1995;3:171–95.
35.
EgelandJABlumenthalRLNeeJSharpeLEndicottJ.Reliability and relationship of various age of onset criteria for major affective disorder. J Affect Diord1987;12:159–65.
36.
PostRMSilbersteinSD. Shared mechanisms in affective illness, epilepsy, and migraine. Neurology1994;44(suppl 7):S37–S47.
37.
SlaterE.Zur Periodik des manisch-depressiven Irreseins. Z Gesamte Neurol Psychiatrie1938;162:794–801.
38.
OepenGSalvatorePBaldessariniRJ. On the periodicity of manic-depressive insanity by Eliot Slater (1938): Translation and commentary. J Affect Disord2003. Forthcoming.
39.
FeksiATKaamugishaJSanderJWASGatitiSShorvonSD. Comprehensive primary health care antiepileptic drug treatment program in rural and semi-urban Kenya. Lancet1991;337:406–9.
40.
WattsAE. The natural history of untreated epilepsy in a rural community in Africa. Epilepsia1992;33:464–8.
41.
PlacenciaMSanderJWASShorvonSDRomanMAlarconFBimosC, and others. Antiepileptic drug treatment in a community health care setting in northern Ecuador: A prospective 12-month assessment. Epilepsy Res1993;14:237–44.
42.
MusiccoMBeghiESolariAVianiF.Treatment of first tonic-clonic seizure does not improve the prognosis of epilepsy. Neurology1997;49:991–8.
