Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-25T19:49:18.948Z Has data issue: false hasContentIssue false
  • English
  • Français

Continuous circular cycling as a predictor of treatment response in bipolar disorders: a comprehensive review of the current literature

Published online by Cambridge University Press:  15 March 2017

Antonio Tundo  and
Paola Cavalieri
Antonio Tundo*
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Paola Cavalieri
Affiliation:
Istituto di Psicopatologia, Rome, Italy
*
*Address for correspondence: Antonio Tundo, Istituto di Psicopatologia, Via Girolamo da Carpi 1, 00196 Rome, Italy. (Email: tundo@istitutodipsicopatologia.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Evidence from the literature suggests that, on average, 27% of patients with a bipolar disorder (BD) experience a continuous cycling course (CCC) and that this subgroup differs significantly from patients with a noncontinuous cycling course (N-CCC) with respect to sociodemographic characteristics and clinical presentation. The aim of the present paper is to review the studies that evaluated short- and long-term treatment responses in BD patients with CCC. The retrieved studies indicate that CCC is a significant predictor of poor response to long-term treatment with lithium (the odds of a response in the CCC group were 57% less than in the N-CCC group; p<0.01), as well as to polytherapies including lithium and/or an antiepileptic augmented, when necessary, with an antipsychotic and/or antidepressant. The percentage of patients without new episodes during follow-up was significantly lower in the CCC group compared with the N-CCC group (15.4 vs. 37.6% , p<0.01). Compared with patients in the N-CCC group, members of the CCC group had a poorer response and lower remission rates after 12-week antidepressant treatments for a major depressive episode (82.3 vs. 50%, p =0.002; 69.6 vs. 40.9%, p=0.013). These findings, underlining that CCC is a predictor of poor response to short- and long-term treatment in BD, should be interpreted considering the limitations of the reviewed studies (the small sample sizes, the small number of trials and their observational nature, the lack of randomization or placebo controls, and the unblinded nature of the outcomes). Clinical trials and observational studies with larger samples are warranted to confirm the conclusions of our review.

Keywords

Bipolar disorderscoursebipolar depressionlong-term treatmentantidepressant
Type
Review Articles
Information
CNS Spectrums , Volume 23 , Issue 1 , February 2018 , pp. 24 - 28
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Baillarger, JGF. Note sur un genre de folie dont les accès sont caractérisés par deux périodes régulières, l’une de depression et l’autre d’excitation [in French]. Bull Acad Natl Méd. 1854; 19: 340–352.Google Scholar
2. Kukopoulos, A, Reginaldi, D, Laddomada, P, Floris, G, Serra, G, Tondo, L. Course of the manic-depressive cycle and changes caused by treatments. Pharmakopsychiatr Neuropsychopharmakol. 1980; 13(4): 156–167.Google Scholar
3. Maj, M, Pirozzi, R, Formicola, AM, Tortorella, A. Reliability and validity of four alternative definitions of rapid-cycling bipolar disorder. Am J Psychiatry. 1999; 156(9): 1421–1424; http://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.156.9.1421. Accessed February 9, 2017.Google Scholar
4. Tundo, A, Calabrese, JR, Marchetti, F, Dell’Osso, L, Proietti, L, De Filippis, R. Continuous circular cycling in bipolar disorder as a predictor of poor outcome. J Affect Disord. 2013; 150(3): 823–828.Google Scholar
5. Maj, M, Pirozzi, R, Starace, F. Previous pattern of course of the illness as a predictor of response to lithium prophylaxis in bipolar patients. J Affect Disord. 1989; 17(3): 237–241.CrossRefGoogle ScholarPubMed
6. Grof, E, Haag, M, Grof, P, Haag, H. Lithium response and the sequence of episode polarities: preliminary report on a Hamilton sample. Prog Neuropsychopharmacol Biol Psychiatry. 1987; 11(2–3): 199–203.Google Scholar
7. Haag, M, Heidorn, A, Haag, H, Greil, W. Response to stabilising lithium therapy and sequence of affective polarity. Pharmacopsychiatry. 1986; 19(4): 278–279.CrossRefGoogle Scholar
8. Faedda, GL, Baldessarini, RJ, Tohen, M, Strakowski, SM, Waternaux, C. Episode sequence in bipolar disorder and response to lithium treatment. Am J Psychiatry. 1991; 148(9): 1232–1239.Google ScholarPubMed
9. Kleindienst, N, Engel, RR, Greil, W. Which clinical factors predict response to prophylactic lithium? A systematic review for bipolar disorders. Bipolar Disord . 2005; 7(5): 407–417.CrossRefGoogle ScholarPubMed
10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994. https://justines2010blog.files.wordpress.com/2011/03/dsm-iv.pdf. Accessed February 9, 2017.Google Scholar
11. Kukopoulos, A, Caliari, B, Tundo, A, et al. Rapid cyclers, temperament, and antidepressants. Compr Psychiatry.. 1983; 24(3): 249–258.Google Scholar
12. Wehr, TA, Sack, DA, Rosenthal, NE, Cowdry, RW. Rapid cycling affective disorder: contributing factors and treatment responses in 51 patients. Am J Psychiatry. 1988; 145(2): 179–184.Google ScholarPubMed
13. Baldessarini, RJ, Tondo, L, Floris, G, Hennen, J. Effects of rapid cycling on response to lithium maintenance treatment in 360 bipolar I and II disorder patients. J Affect Disord. 2000; 61(1–2): 13–22.CrossRefGoogle ScholarPubMed
14. Spearing, MK, Post, RM, Leverich, GS, Brandt, D, Nolen, W. Modification of the Clinical Global Impression (CGI) scale for use in bipolar illness (BP): the CGI–BP. Psychiatry Res. 1997; 73(3): 159–171.Google Scholar
15. Tundo, A, Calabrese, JR, Proietti, L, de Filippis, R. Variation in response to short-term antidepressant treatment between patients with continuous and non-continuous cycling bipolar disorders. J Affect Disord. 2015; 174: 126–130; Epub ahead of print Nov 27, 2014.Google Scholar
16. Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960; 23: 56–62; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC495331/. Accessed February 9, 2017.CrossRefGoogle ScholarPubMed
17. Pacchiarotti, I, Bond, DJ, Baldessarini, RJ, et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry. 2013; 170(11): 1249–1262; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4091043/. Accessed February 9, 2017.Google Scholar