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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1932-1939 |
| Number of pages | 8 |
| Journal | Neuropsychopharmacology |
| Volume | 30 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2005 |
Fingerprint
Keywords
- Bipolar disorder
- Divalproex
- Dysphoric
- Euphoric
- Lithium
- Maintenance
ASJC Scopus subject areas
- Pharmacology
Cite this
Relationship of mania symptomatology to maintenance treatment response with divalproex, lithium, or placebo. / Bowden, Charles L.; Collins, Michelle A.; McElroy, Susan L.; Calabrese, Joseph R.; Swann, Alan C.; Weisler, Richard H.; Wozniak, Patricia J.
In: Neuropsychopharmacology, Vol. 30, No. 10, 10.2005, p. 1932-1939.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Relationship of mania symptomatology to maintenance treatment response with divalproex, lithium, or placebo
AU - Bowden, Charles L.
AU - Collins, Michelle A.
AU - McElroy, Susan L.
AU - Calabrese, Joseph R.
AU - Swann, Alan C.
AU - Weisler, Richard H.
AU - Wozniak, Patricia J.
PY - 2005/10
Y1 - 2005/10
N2 - 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.
AB - 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.
KW - Bipolar disorder
KW - Divalproex
KW - Dysphoric
KW - Euphoric
KW - Lithium
KW - Maintenance
UR - http://www.scopus.com/inward/record.url?scp=27144520494&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=27144520494&partnerID=8YFLogxK
U2 - 10.1038/sj.npp.1300788
DO - 10.1038/sj.npp.1300788
M3 - Article
C2 - 15956987
AN - SCOPUS:27144520494
VL - 30
SP - 1932
EP - 1939
JO - Neuropsychopharmacology
JF - Neuropsychopharmacology
SN - 0893-133X
IS - 10
ER -