@article{6b47f044ed9d49d4aa069aa6f3944d6f,
title = "Relationship of mania symptomatology to maintenance treatment response with divalproex, lithium, or placebo",
abstract = "Euphoric and mixed (dysphoric) manic symptoms have different response patterns to divalproex and lithium in acute mania treatment, but have not been studied in relationship to maintenance treatment outcomes. We examined the impact of initial euphoric or dysphoric manic symptomatology on maintenance outcome. Randomized maintenance treatment with divalproex, lithium, or placebo was provided for 372 bipolar I patients, who met improvement criteria during open phase treatment for an index manic episode. The current analysis grouped patients according to the index manic episode subtype (euphoric or dysphoric), and evaluated the impact on maintenance treatment outcome. The rate of early discontinuation due to intolerance during maintenance treatment was higher for initially dysphoric patients (N=249) than euphoric patients (N=123; 15.7 vs 7.3%, respectively; p=0.032). Both lithium (23.2%) and divalproex (17.1%) were associated with more premature discontinuations due to intolerance than placebo (4.8%; p=0.003 and 0.02, respectively) in the initially dysphoric patients. Among initially euphoric patients, treatment with lithium was associated with significantly more premature discontinuations due to intolerance compared to placebo (18.2 vs 0%; p=0.03), and divalproex was significantly (p=0.05) more effective than lithium, but not placebo in delaying time to a depressive episode. Initial euphoric mania appeared to predispose to better outcomes on indices of depression and overall function with divalproex maintenance than with either placebo or lithium. Dysphoric mania appeared to predispose patients to more side effects when treated with either divalproex or lithium during maintenance therapy.",
keywords = "Bipolar disorder, Divalproex, Dysphoric, Euphoric, Lithium, Maintenance",
author = "Bowden, {Charles L.} and Collins, {Michelle A.} and McElroy, {Susan L.} and Calabrese, {Joseph R.} and Swann, {Alan C.} and Weisler, {Richard H.} and Wozniak, {Patricia J.}",
note = "Funding Information: This study was supported by a grant from Abbott Laboratories, Abbott Park, IL. The following members of the Divalproex Maintenance Study Group took part in this study: Paul E Alexander, MD, Psychiatric Foundation for Research and Education, Warwick, RI; Charles Bowden, MD, University of Texas Health Science Center, San Antonio, TX; Joseph R Calabrese, MD, Case Western Reserve School of Medicine, Cleveland, OH; Jeffery Clothier, MD, University of Arkansas Medical School, Little Rock, AR; Robert Cooke, MD, Clarke Institute of Psychiatry, Toronto, Canada; William Coryell, MD, University of Iowa Hospitals and Clinics, Iowa City, IA; James C-Y Chou, MD, New York University School of Medicine, New York, NY; Scott Crow, MD, University of Minnesota Hospital, Minneapolis, MN; Pedro Delgado, MD, University of Arizona College of Medicine, Tucson, AZ; John Downs, MD, University of Tennessee, Memphis, TN; Dwight Evans, MD, University of Florida College of Medicine, Gainesville, FL (currently of University of Pennsylvania Medical Center, Philadelphia, PA); Arlene F Frank, MD, Brookside Hospital, Nashua, NH; Robert Gerner, MD, University of California Center for Mood Disorders, Los Angeles, CA; William J Giakas, MD, Rockford Psychiatric Medical Services, Rockford, IL; Ira David Glick, MD, Stanford University School of Medicine, Stanford, CA; Robert MA Hirschfeld, MD, University of Texas Medical Branch, Galveston, TX; Steven Parker James, MD, Yorba Hills Medical Plaza, Yorba Linda, CA; Philip G Janicak, MD, Illinois State Psychiatric Institute, Chicago, IL; James W Jefferson, MD, Dean Foundation for Health, Research, and Education, Madison, WI; Paul E Keck Jr, MD, University of Cincinnati College of Medicine, Cincinnati, OH; Barbara L Kennedy, MD, PhD, University of Louisville, Louisville, KY; K Ranga Rama Krishnan, MD, Duke University Medical Center, Durham, NC; Susan McElroy, MD, University of Cincinnati College of Medicine, Cincinnati, OH; B Raj Nakra, MD, Washington University School of Medicine, Saint Louis, MO; Henry A Nasrallah, MD, Ohio State University College of Medicine, Columbus, OH; Charles B Nemeroff, MD, PhD, Emory University School of Medicine, Atlanta, GA; William M Patterson, MD, Birmingham Research Group, Inc., Birmingham, AL; Frederick Petty, MD, PhD, University of Texas South-western Medical Center, Dallas, TX; Alan H Rosenbaum, MD, Comprehensive Psychiatric Services, Farmington Hills, MI; David Vincent Sheehan, MD, University of South Florida Psychiatry Center, Tampa, FL; Alan C Swann, MD, University of Texas Medical School at Houston, Houston, TX; Craig S Risch, MD, Medical University of South Carolina, Charleston, SC; Richard L Wang, MD, Milwaukee County Medical Complex, Milwaukee, WI; Adel Wassef, MD, University of Texas-Houston Health Science Center, Houston, TX; Richard H Weisler, MD, Raleigh, NC; Phillip Wilner, MD, Payne Whitney Psychiatric Clinic, New York City, NY; Patricia J Wozniak, Abbott Laboratories, North Chicago, IL. Funding Information: Dr Bowden is a consultant for Abbott Laboraties, GlaxoSmithKline, Pfizer, Astra Zeneca, Sanofi Aventis, and Eli Lilly. He has research grants from the National Institute of Mental Health, Abbott Laboratories, GlaxoSmithKline, Bristol Myers Squibb, Janssen, and Eli Lilly Dr Collins is an employee of Abbott Laboratories. Funding Information: Dr McElroy is a consultant to Abbott Laboratories and a member of the company{\textquoteright}s Speakers Bureau and Divalproex Advisory Board. She has also received research grants from Abbott Laboratories and Eli Lilly and Company. Funding Information: Dr Calabrese is a consultant to Abbott Laboratories, a member of the Divalproex Advisory Board, and has received research grants support from Abbott Laboratories. Funding Information: Dr Swann has received grant support from Abbott Laboratories, GlaxoSmithKline, UCB Pharma, Bristol-Myers Squibb, Eli Lilly and Company, and Shire Laboratories. He has served as a consultant for Abbott Laboratories, Pfizer Laboratories, Shire Laboratories, UCB Pharma, Glaxo-SmithKline, Novartis, Eli Lilly and Company, and Bristol-Myers Squibb. He has served on Speakers{\textquoteright} Bureaus for Abbott Laboratories, Janssen Pharmaceutica, Novartis, GlaxoSmithKline, and Pfizer Laboratories. Funding Information: Dr Weisler has received grant support from Pfizer, Eli Lilly, Glaxo SmithKline, Abbott, Merck, Organon, Biovail, Shire, Sanofi-Synthelabo, Astra Zeneca Janssen, Bristol Myers Squibb, Wyeth Ayerst, Solvay, Novartis, Schwabe, TAP Pharmaceutical, Synaptic Pharmaceutical Incorporated, Eisai, UCB Pharma, Inc., Cephalon, Lundbeck, Forest, and Pharmacia. He has served as a consultant/advisor to Pfizer, Glaxo Smithkline, Bristol Myers Squibb, Biovail, Lilly, Wyeth Ayerst, Shire, Organon, Sanofi-Synthelabo, Forest, Solvay, AstraZeneca, Cephalon, and Abbott Laboratories. He is a stockholder of Merck, Pfizer, and Bristol Myers Squibb. Dr Wozniak is an employee of Abbott Laboratories.",
year = "2005",
month = oct,
doi = "10.1038/sj.npp.1300788",
language = "English (US)",
volume = "30",
pages = "1932--1939",
journal = "Neuropsychopharmacology",
issn = "0893-133X",
publisher = "Nature Publishing Group",
number = "10",
}