Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar i or II disorder

Results from the Bipolar CHOICE trial

William V. Bobo, Noreen A. Reilly-Harrington, Terence A. Ketter, Benjamin D. Brody, Gustavo Kinrys, David E. Kemp, Richard C. Shelton, Susan L. McElroy, Louisa G. Sylvia, James H. Kocsis, Melvin G. McInnis, Edward S. Friedman, Vivek Singh, Mauricio Tohen, Charles L. Bowden, Thilo Deckersbach, Joseph R. Calabrese, Michael E. Thase, Andrew A. Nierenberg, Dustin J. Rabideau & 3 others David A. Schoenfeld, Stephen V. Faraone, Masoud Kamali

Research output: Contribution to journalArticle

Abstract

Background Little is known about the longer-term effects of adjunctive benzodiazepines on symptom response during treatment in patients with bipolar disorders. Methods The study sample consisted of 482 patients with bipolar I or II disorder enrolled in a 6-month, randomized, multi-site comparison of lithium- and quetiapine-based treatment. Changes in clinical measures (BISS total and subscales, CGI-BP, and CGI-Efficacy Index) were compared between participants who did and did not receive benzodiazepine treatment at baseline or during follow-up. Selected outcomes were also compared between patients who did and did not initiate benzodiazepines during follow-up using stabilized inverse probability weighted analyses. Results Significant improvement in all outcome measures occurred within each benzodiazepine exposure group. Benzodiazepine users (at baseline or during follow-up) experienced significantly less improvement in BISS total, BISS irritability, and CGI-BP scores than did benzodiazepine non-users. There were no significant differences in these measures between patients who did and did not initiate benzodiazepines during follow-up in the weighted analyses. There was no significant effect of benzodiazepine use on any outcome measure in patients with comorbid anxiety or substance use disorders. Limitations This is a secondary analysis of data from a randomized effectiveness trial that was not designed to address differential treatment response according to benzodiazepine use. Conclusions Adjunctive benzodiazepines may not significantly affect clinical outcome in lithium- or quetiapine-treated patients with bipolar I or II disorder over 6 months, after controlling for potential confounding factors.

Original languageEnglish (US)
Pages (from-to)30-35
Number of pages6
JournalJournal of Affective Disorders
Volume161
DOIs
StatePublished - Jun 1 2014
Externally publishedYes

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Benzodiazepines
Bipolar Disorder
Lithium
Outpatients
Outcome Assessment (Health Care)
Quetiapine Fumarate
Therapeutics
Substance-Related Disorders
Anxiety

Keywords

  • Benzodiazepines
  • Bipolar disorder
  • Clinical outcome
  • Lithium
  • Quetiapine

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology
  • Medicine(all)

Cite this

Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar i or II disorder : Results from the Bipolar CHOICE trial. / Bobo, William V.; Reilly-Harrington, Noreen A.; Ketter, Terence A.; Brody, Benjamin D.; Kinrys, Gustavo; Kemp, David E.; Shelton, Richard C.; McElroy, Susan L.; Sylvia, Louisa G.; Kocsis, James H.; McInnis, Melvin G.; Friedman, Edward S.; Singh, Vivek; Tohen, Mauricio; Bowden, Charles L.; Deckersbach, Thilo; Calabrese, Joseph R.; Thase, Michael E.; Nierenberg, Andrew A.; Rabideau, Dustin J.; Schoenfeld, David A.; Faraone, Stephen V.; Kamali, Masoud.

In: Journal of Affective Disorders, Vol. 161, 01.06.2014, p. 30-35.

Research output: Contribution to journalArticle

Bobo, WV, Reilly-Harrington, NA, Ketter, TA, Brody, BD, Kinrys, G, Kemp, DE, Shelton, RC, McElroy, SL, Sylvia, LG, Kocsis, JH, McInnis, MG, Friedman, ES, Singh, V, Tohen, M, Bowden, CL, Deckersbach, T, Calabrese, JR, Thase, ME, Nierenberg, AA, Rabideau, DJ, Schoenfeld, DA, Faraone, SV & Kamali, M 2014, 'Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar i or II disorder: Results from the Bipolar CHOICE trial', Journal of Affective Disorders, vol. 161, pp. 30-35. https://doi.org/10.1016/j.jad.2014.02.046
Bobo, William V. ; Reilly-Harrington, Noreen A. ; Ketter, Terence A. ; Brody, Benjamin D. ; Kinrys, Gustavo ; Kemp, David E. ; Shelton, Richard C. ; McElroy, Susan L. ; Sylvia, Louisa G. ; Kocsis, James H. ; McInnis, Melvin G. ; Friedman, Edward S. ; Singh, Vivek ; Tohen, Mauricio ; Bowden, Charles L. ; Deckersbach, Thilo ; Calabrese, Joseph R. ; Thase, Michael E. ; Nierenberg, Andrew A. ; Rabideau, Dustin J. ; Schoenfeld, David A. ; Faraone, Stephen V. ; Kamali, Masoud. / Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar i or II disorder : Results from the Bipolar CHOICE trial. In: Journal of Affective Disorders. 2014 ; Vol. 161. pp. 30-35.
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abstract = "Background Little is known about the longer-term effects of adjunctive benzodiazepines on symptom response during treatment in patients with bipolar disorders. Methods The study sample consisted of 482 patients with bipolar I or II disorder enrolled in a 6-month, randomized, multi-site comparison of lithium- and quetiapine-based treatment. Changes in clinical measures (BISS total and subscales, CGI-BP, and CGI-Efficacy Index) were compared between participants who did and did not receive benzodiazepine treatment at baseline or during follow-up. Selected outcomes were also compared between patients who did and did not initiate benzodiazepines during follow-up using stabilized inverse probability weighted analyses. Results Significant improvement in all outcome measures occurred within each benzodiazepine exposure group. Benzodiazepine users (at baseline or during follow-up) experienced significantly less improvement in BISS total, BISS irritability, and CGI-BP scores than did benzodiazepine non-users. There were no significant differences in these measures between patients who did and did not initiate benzodiazepines during follow-up in the weighted analyses. There was no significant effect of benzodiazepine use on any outcome measure in patients with comorbid anxiety or substance use disorders. Limitations This is a secondary analysis of data from a randomized effectiveness trial that was not designed to address differential treatment response according to benzodiazepine use. Conclusions Adjunctive benzodiazepines may not significantly affect clinical outcome in lithium- or quetiapine-treated patients with bipolar I or II disorder over 6 months, after controlling for potential confounding factors.",
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T1 - Effect of adjunctive benzodiazepines on clinical outcomes in lithium- or quetiapine-treated outpatients with bipolar i or II disorder

T2 - Results from the Bipolar CHOICE trial

AU - Bobo, William V.

AU - Reilly-Harrington, Noreen A.

AU - Ketter, Terence A.

AU - Brody, Benjamin D.

AU - Kinrys, Gustavo

AU - Kemp, David E.

AU - Shelton, Richard C.

AU - McElroy, Susan L.

AU - Sylvia, Louisa G.

AU - Kocsis, James H.

AU - McInnis, Melvin G.

AU - Friedman, Edward S.

AU - Singh, Vivek

AU - Tohen, Mauricio

AU - Bowden, Charles L.

AU - Deckersbach, Thilo

AU - Calabrese, Joseph R.

AU - Thase, Michael E.

AU - Nierenberg, Andrew A.

AU - Rabideau, Dustin J.

AU - Schoenfeld, David A.

AU - Faraone, Stephen V.

AU - Kamali, Masoud

PY - 2014/6/1

Y1 - 2014/6/1

N2 - Background Little is known about the longer-term effects of adjunctive benzodiazepines on symptom response during treatment in patients with bipolar disorders. Methods The study sample consisted of 482 patients with bipolar I or II disorder enrolled in a 6-month, randomized, multi-site comparison of lithium- and quetiapine-based treatment. Changes in clinical measures (BISS total and subscales, CGI-BP, and CGI-Efficacy Index) were compared between participants who did and did not receive benzodiazepine treatment at baseline or during follow-up. Selected outcomes were also compared between patients who did and did not initiate benzodiazepines during follow-up using stabilized inverse probability weighted analyses. Results Significant improvement in all outcome measures occurred within each benzodiazepine exposure group. Benzodiazepine users (at baseline or during follow-up) experienced significantly less improvement in BISS total, BISS irritability, and CGI-BP scores than did benzodiazepine non-users. There were no significant differences in these measures between patients who did and did not initiate benzodiazepines during follow-up in the weighted analyses. There was no significant effect of benzodiazepine use on any outcome measure in patients with comorbid anxiety or substance use disorders. Limitations This is a secondary analysis of data from a randomized effectiveness trial that was not designed to address differential treatment response according to benzodiazepine use. Conclusions Adjunctive benzodiazepines may not significantly affect clinical outcome in lithium- or quetiapine-treated patients with bipolar I or II disorder over 6 months, after controlling for potential confounding factors.

AB - Background Little is known about the longer-term effects of adjunctive benzodiazepines on symptom response during treatment in patients with bipolar disorders. Methods The study sample consisted of 482 patients with bipolar I or II disorder enrolled in a 6-month, randomized, multi-site comparison of lithium- and quetiapine-based treatment. Changes in clinical measures (BISS total and subscales, CGI-BP, and CGI-Efficacy Index) were compared between participants who did and did not receive benzodiazepine treatment at baseline or during follow-up. Selected outcomes were also compared between patients who did and did not initiate benzodiazepines during follow-up using stabilized inverse probability weighted analyses. Results Significant improvement in all outcome measures occurred within each benzodiazepine exposure group. Benzodiazepine users (at baseline or during follow-up) experienced significantly less improvement in BISS total, BISS irritability, and CGI-BP scores than did benzodiazepine non-users. There were no significant differences in these measures between patients who did and did not initiate benzodiazepines during follow-up in the weighted analyses. There was no significant effect of benzodiazepine use on any outcome measure in patients with comorbid anxiety or substance use disorders. Limitations This is a secondary analysis of data from a randomized effectiveness trial that was not designed to address differential treatment response according to benzodiazepine use. Conclusions Adjunctive benzodiazepines may not significantly affect clinical outcome in lithium- or quetiapine-treated patients with bipolar I or II disorder over 6 months, after controlling for potential confounding factors.

KW - Benzodiazepines

KW - Bipolar disorder

KW - Clinical outcome

KW - Lithium

KW - Quetiapine

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