TY - JOUR
T1 - Predictors of non-stabilization during the combination therapy of lithium and divalproex in rapid cycling bipolar disorder
T2 - A post-hoc analysis of two studies
AU - Gao, Keming
AU - Kemp, David E.
AU - Wang, Zuowei
AU - Ganocy, Stephen J.
AU - Conroy, Carla
AU - Serrano, Marry Beth
AU - Sajatovic, Martha
AU - Findling, Robert L.
AU - Calabrese, Joseph R.
PY - 2010/2/15
Y1 - 2010/2/15
N2 - Objective: To study predictors of non-stabilization (i.e., not bimodally stabilized for randomization or not randomized due to premature discontinuation) during open-label treatment with lithium and divalproex in patients with rapid-cycling bipolar disorder (RCBD) with or without comorbid recent substance use disorders (SUDs). Method: Data from the open-label phase of two maintenance studies were used. The reasons for non-stabilization were compared between patients with a recent SUD and those without. Predictors for non-stabilization were explored with logistic regression analyses. Results: Of 149 patients with recent SUD and 254 without recent SUD enrolled into the open-label acute stabilization phase, 21% and 24% were stabilized and randomized, respectively. Compared to those without recent SUD, patients with recent SUD were more likely to discontinue the study due to non-adherence to the protocol, 53% versus 37% (OR = 1.92) or refractory mania/hypomania, 15% versus 9% (OR = 1.87), but less likely due to refractory depression 16% versus 25% (OR = 0.58) or adverse events, 10% versus 19% (OR = 0.44). A history of recent SUDs, early life verbal abuse, female gender, and late onset of first depressive episode were associated with increased risk for non-stabilization with ORs of 1.85, 1.74, 1.10, and 1.04, respectively. Conclusions: During open treatment with lithium and divalproex in patients with RCBD, a recent SUD, a lifetime history of verbal abuse, female gender, and late onset of first depression independently predicted nonstabilization. The non-stabilization for patients with SUD was related to non-adherence and refractory mania/hypomania.
AB - Objective: To study predictors of non-stabilization (i.e., not bimodally stabilized for randomization or not randomized due to premature discontinuation) during open-label treatment with lithium and divalproex in patients with rapid-cycling bipolar disorder (RCBD) with or without comorbid recent substance use disorders (SUDs). Method: Data from the open-label phase of two maintenance studies were used. The reasons for non-stabilization were compared between patients with a recent SUD and those without. Predictors for non-stabilization were explored with logistic regression analyses. Results: Of 149 patients with recent SUD and 254 without recent SUD enrolled into the open-label acute stabilization phase, 21% and 24% were stabilized and randomized, respectively. Compared to those without recent SUD, patients with recent SUD were more likely to discontinue the study due to non-adherence to the protocol, 53% versus 37% (OR = 1.92) or refractory mania/hypomania, 15% versus 9% (OR = 1.87), but less likely due to refractory depression 16% versus 25% (OR = 0.58) or adverse events, 10% versus 19% (OR = 0.44). A history of recent SUDs, early life verbal abuse, female gender, and late onset of first depressive episode were associated with increased risk for non-stabilization with ORs of 1.85, 1.74, 1.10, and 1.04, respectively. Conclusions: During open treatment with lithium and divalproex in patients with RCBD, a recent SUD, a lifetime history of verbal abuse, female gender, and late onset of first depression independently predicted nonstabilization. The non-stabilization for patients with SUD was related to non-adherence and refractory mania/hypomania.
KW - Anxiety disorder
KW - Bipolar disorder
KW - Mood stabilizer
KW - Non-stabilization
KW - Substance use disorder
UR - http://www.scopus.com/inward/record.url?scp=79952904570&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79952904570&partnerID=8YFLogxK
M3 - Article
C2 - 20581798
AN - SCOPUS:79952904570
SN - 0048-5764
VL - 43
SP - 23
EP - 38
JO - Psychopharmacology bulletin
JF - Psychopharmacology bulletin
IS - 1
ER -