Costs of Bipolar Disorder

Kleinman, Leah; Lowin, Ana; Flood, Emuella; Gandhi, Gian; Edgell, E.T.; Revicki, Dennis A.

doi:10.2165/00019053-200321090-00001

Cited by 210 publications

(139 citation statements)

References 69 publications

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“…Our finding that both BPD and MDD are associated with substantial losses in work performance is broadly consistent with other surveys of workplace costs (12,17,18,40,41). The estimated annual population-level workplace cost of MDD, $36.6 billion, is in the range of the two other recent studies that estimated the workplace costs of MDE --$31.0 billion (31) and $51.5 billion (12).…”

Section: Discussionsupporting

confidence: 89%

“…However, with rare exceptions, these studies fail to distinguish MDE associated with MDD and associated with BPD (10)(11)(12)(13). Furthermore, although several recent cost-of-illness studies (14)(15)(16) and reviews (17,18) have focused on the costs of BPD, none has presented comparative information on the workplace costs of MDD and BPD. The current report does this using data from the recently completed National Comorbidity Replication (NCS-R) (19), a nationally representative survey of the prevalence and costs of mental disorders in the US household population.…”

mentioning

confidence: 99%

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Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

Kessler¹

2006

Am J Psychiatry

268

215

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OBJECTIVE-Research on the workplace costs of mood disorders has focused largely on major depressive episodes (MDE). Bipolar disorder (BPD) has been overlooked both by failing to distinguish MDE due to major depressive disorder (MDD) versus BPD and by failing to evaluate the workplace costs of mania and hypomania. METHOD-The National Comorbidity Survey Replication (NCS-R) assessed DSM-IV MDD andBPD with the WHO Composite International Diagnostic Interview (CIDI) and assessed work impairment with the WHO Health and Work Performance Questionnaire (HPQ). Regression analysis of MDD and BPD predicting HPQ among workers (n = 3378) was used to estimate the workplace costs of mood disorders.RESULTS-1.1% of workers met CIDI criteria for 12-month BPD (bipolar I or bipolar II) and 6.4% for 12-month MDD. BPD was associated with 65.5 and MDD with 27.2 annual lost workdays per ill worker. Subgroup analysis showed that the higher work loss associated with BPD than MDD is due to more severe and persistent MDE in BPD than MDD rather than to stronger effects of maniahypomania than depression. Annual human capital loss per ill worker was estimated at $9619 for BPD and $4426 for MDD. Annual projections to the US labor force were $14.1 billion for BPD and $36.6 billion for MDD.CONCLUSIONS-Employer interest in the workplace costs of mood disorders should be broadened beyond MDD to include BPD. Effectiveness trials are needed to study the return on employer investment of coordinated programs for workplace screening and treatment of BPD and MDD.Although bipolar disorder has traditionally been thought to have a lifetime prevalence of about 1% in the population (1,2), a substantial upward revision of this estimate is occurring based on mounting evidence for a broad bipolar spectrum that includes people with a history of hypomania, sub-threshold manic symptoms, and medication-induced manic symptoms (3-5). The bipolar spectrum is now thought to characterize as much as 5% of the general population (6). People with bipolar spectrum disorder spend a considerably higher proportion of time with (7,8), resulting in frequent confusion between depressive episode (MDE) due to major depressive disorder (MDD) and due to bipolar disorder (9). Failure to make this distinction can have dire clinical implications.The same distinction between MDD and bipolar disorder (BPD) would be useful to make in depression cost-of-illness studies. However, with rare exceptions, these studies fail to distinguish MDE associated with MDD and associated with BPD (10-13). Furthermore, although several recent cost-of-illness studies (14-16) and reviews (17,18) have focused on the costs of BPD, none has presented comparative information on the workplace costs of MDD and BPD. The current report does this using data from the recently completed National Comorbidity Replication (NCS-R) (19), a nationally representative survey of the prevalence and costs of mental disorders in the US household population. METHODS SampleThe NCS-R is a nationally representative survey of me...

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

Kessler¹

2006

Am J Psychiatry

268

215

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“…6 Their overall quality of life is profoundly altered, as are social relationships, finances, career and family. Bipolar disorder is a major economic burden 7,8 with the estimated 1998 lifetime cost of individual cases in the United States ranging from US$11 720 for persons with a single manic episode to $624 785 for those with non-responsive/chronic episodes. 9 Despite being treated pharmacologically for over 50 years 10 there is a clear need for improved treatment of the disease.…”

Section: Background On Bipolar Disordermentioning

confidence: 99%

Mode of action of mood stabilizers: is the arachidonic acid cascade a common target?

et al. 2008

Mol Psychiatry

108

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Bipolar disorder is a major medical, social and economic burden worldwide. However, the mechanisms of action of effective antibipolar disorder drugs remain elusive. In this paper, we review studies using a neuropharmacological approach in unanesthetized rats, combined with kinetic, biochemical and molecular biology techniques, showing that chronic administration of three Food and Drug Administration-approved mood stabilizers (lithium, valproate and carbamazepine) at therapeutically relevant doses, selectively target the brain arachidonic acid (AA) cascade. Whereas chronic lithium and carbamazepine decrease the binding activity of activator protein-2 and in turn the transcription, translation and activity of its AA-selective calcium-dependent phospholipase A 2 gene product, valproate appears to be a non-competitive inhibitor of long-chain acyl-CoA synthetase. The net overlapping effects of the three drugs are decreased turnover of AA but not of docosahexaenoic acid in rat brain phospholipids, and decreased brain cyclooxygenase-2 and prostaglandin E 2 . Although these observations support the hypothesis proposed by Rapoport and colleagues that the AA cascade is a common target of mood stabilizers, this hypothesis is not necessarily exclusive of other targets. Targeting the AA cascade with drugs or diet may be a useful therapeutic approach in bipolar disorder, and examining the AA cascade in patients might help in better understanding the disease.

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“…Bipolar disorder (BPD) is a highly prevalent, challenging-totreat psychiatric disorder that can greatly impact daily functioning (Goetzel et al, 2003;Kleinman et al, 2003). BPD is present in 1-5% of the worldwide population (Angst, 1998;Ferrari et al, 2011;Merikangas et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

A Randomized, Double-Blind, Placebo-Controlled Trial of Pregnenolone for Bipolar Depression

Brown

Park

Marx

et al. 2014

Neuropsychopharmacol

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Depression in bipolar disorder (BPD) is challenging to treat. Therefore, additional medication options are needed. In the current report, the effect of the neurosteroid pregnenolone on depressive symptoms in BPD was examined. Adults (n ¼ 80) with BPD, depressed mood state, were randomized to pregnenolone (titrated to 500 mg/day) or placebo, as add-on therapy, for 12 weeks. Outcome measures included the 17-item Hamilton Rating Scale for Depression (HRSD), Inventory of Depressive Symptomatology-Self-Report (IDS-SR), Hamilton Rating Scale for Anxiety (HRSA), and Young Mania Rating Scale (YMRS). Serum neurosteroid levels were assessed at baseline and week 12. Data were analyzed using a mixed model ANCOVA with a between factor of treatment assignment, a within factor (repeated) of visit, and the baseline value, as well as age and gender, as covariates. In participants with at least one postbaseline visit (n ¼ 73), a significant treatment by week interaction for the HRSD (F(5,288) ¼ 2.61, p ¼ 0.025), but not IDS-SR, was observed. Depression remission rates were greater in the pregnenolone group (61%) compared with the placebo group (37%), as assessed by the IDS-SR (w 2 (1) ¼ 3.99, p ¼ 0.046), but not the HRSD. Large baseline-to-exit changes in neurosteroid levels were observed in the pregnenolone group but not in the placebo group. In the pregnenolone group, baseline-to-exit change in the HRSA correlated negatively with changes in allopregnanolone (r(22) ¼ À 0.43, p ¼ 0.036) and pregNANolone (r(22) ¼ À 0.48, p ¼ 0.019) levels. Pregnenolone was well tolerated. The results suggest that pregnenolone may improve depressive symptoms in patients with BPD and can be safely administered.

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Costs of Bipolar Disorder

Cited by 210 publications

References 69 publications

Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers

Mode of action of mood stabilizers: is the arachidonic acid cascade a common target?

A Randomized, Double-Blind, Placebo-Controlled Trial of Pregnenolone for Bipolar Depression

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