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Comparison of treatment outcome using two definitions of rapid cycling in subjects with bipolar II disorder
Author(s) -
Amsterdam Jay D,
LorenzoLuaces Lorenzo,
DeRubeis Robert J
Publication year - 2017
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/bdi.12462
Subject(s) - hypomania , rapid cycling , bipolar ii disorder , psychology , bipolar disorder , mood , lithium (medication) , depression (economics) , mania , clinical psychology , psychiatry , economics , macroeconomics
Objectives We examined differences in treatment outcome between Diagnostic and Statistical Manual Fourth Edition (DSM‐IV)‐defined rapid cycling and average lifetime‐defined rapid cycling in subjects with bipolar II disorder. We hypothesized that, compared with the DSM‐IV definition, the average lifetime definition of rapid cycling may better identify subjects with a history of more mood lability and a greater likelihood of hypomanic symptom induction during long‐term treatment. Methods Subjects ≥18 years old with a bipolar II major depressive episode (n=129) were categorized into DSM‐IV‐ and average lifetime‐defined rapid cycling and prospectively treated with either venlafaxine or lithium monotherapy for 12 weeks. Responders (n=59) received continuation monotherapy for six additional months. Results These exploratory analyses found moderate agreement between the two rapid‐cycling definitions (κ=0.56). The lifetime definition captured subjects with more chronic courses of bipolar II depression, whereas the DSM‐IV definition captured subjects with more acute symptoms of hypomania. There was no difference between rapid‐cycling definitions with respect to the response to acute venlafaxine or lithium monotherapy. However, the lifetime definition was slightly superior to the DSM‐IV definition in identifying subjects who went on to experience hypomanic symptoms during continuation therapy. Conclusions Although sample sizes were limited, the findings suggest that the lifetime definition of rapid cycling may identify individuals with a chronic rapid‐cycling course and may also be slightly superior to the DSM‐IV definition in identifying individuals with hypomania during relapse‐prevention therapy. These findings are preliminary in nature and need replication in larger, prospective, bipolar II studies.