Preventing the Malignant Transformation of Bipolar Disorder

Post, Robert M.

doi:10.1001/jama.2018.0322

Cited by 25 publications

(13 citation statements)

References 9 publications

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“…Beyond the obvious first‐order economic incentives, our findings suggest it is beneficial to introduce policies that increase workforce participation and income among individuals with early‐onset mood disorders. After mood disorder onset, early and rapid intervention should be a top priority to prevent the progression of the disease (Post, ), and to help individuals with mood disorders regain their capacity to work or to study.…”

Section: Discussionmentioning

confidence: 99%

Bipolar disorder and depression in early adulthood and long‐term employment, income, and educational attainment: A nationwide cohort study of 2,390,127 individuals

2019

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Background: Mood disorders are known to be associated with poor socioeconomic outcomes, but no study has examined these associations across the entire worklife course. Our goal was to estimate the associations between bipolar disorder and depression in early adulthood and subsequent employment, income, and educational attainment.Methods: We conducted a nationwide prospective cohort study including all individuals (n = 2,390,127; 49% female) born in Denmark between 1955 and 1990.Hospital-based diagnoses of depression and bipolar disorder before age 25 were obtained from the Danish psychiatric register. Yearly employment, earnings, and education status from ages 25 to 61 were obtained from the Danish labor market and education registers. We estimated both absolute and relative proportions.Results: Population rates of hospital-diagnosed depression and bipolar between ages 15-25 were 1% and 0.12%, respectively. Compared to individuals without mood disorders, those with depression and particularly bipolar disorder had consistently poor socioeconomic outcomes across the entire work-life span. For example, at age 30, 62% of bipolar and 53% of depression cases were outside the workforce compared to 19% of the general population, and 52% of bipolar and 42% of depression cases had no higher education compared to 27% of the general population. Overall, individuals with bipolar disorder or depression earned around 36% and 51%, respectively, of the income earned by individuals without mood disorders. All associations were smaller for individuals not rehospitalized after age 25.Conclusions: Severe mood disorders with onset before age 25, particularly bipolar disorder, are associated with persistent poor socioeconomic outcomes across the entire work-life course. K E Y W O R D Sbipolar disorder, depression, mood disorders, register based study, socioeconomic outcomes

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Section: Discussionmentioning

confidence: 99%

Bipolar disorder and depression in early adulthood and long‐term employment, income, and educational attainment: A nationwide cohort study of 2,390,127 individuals

2019

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“…This memory engram appears based on epigenetic marks left on histones, DNA, and mRNA that convey sensitization (increased reactivity) to the recurrence not only of stressors but also mood episodes and bouts of substance abuse (13). There also appears to be cross-sensitization among these three types of increased reactivities, which further drive illness progression (7,13,15,16). In addition, in the recurrent mood disorders, after the appearance of enough stress-induced episodes, depressions can also begin to emerge in the absence of precipitating stressors, following a kindling-like progression to spontaneous episodes (12,13).…”

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confidence: 99%

Myriad of implications of acetyl- l -carnitine deficits in depression

Post

2018

Proc. Natl. Acad. Sci. U.S.A.

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“…And this brings us back to Post's 2 cancer metaphor. If we accept it (and I do), we can use it as a lens to help us critically examine our treatments for bipolar disorder.…”

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confidence: 99%

“…Our lead article this month covers a study by Lähteenvuo et al 1 that addresses a topic that should be of interest to all of our readers: what is the real‐world effectiveness of different drug treatments for bipolar disorder? This paper would be important at any time, but its appearance at this moment seems particularly fortuitous, in light of a recent opinion piece by Post 2 in the Journal of the American Medical Association , one of the most influential journals in medicine. In his piece, Post draws an analogy to cancer in formulating his plea for a more aggressive approach to the management of bipolar disorder in order to prevent its “malignant transformation.”…”

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confidence: 99%

Bipolar disorder, lithium, and the task ahead

Price¹

2018

Psychopharmacology Update

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Our lead article this month covers a study by Lähteenvuo et al. that addresses a topic that should be of interest to all of our readers: what is the real‐world effectiveness of different drug treatments for bipolar disorder? This paper would be important at any time, but its appearance at this moment seems particularly fortuitous, in light of a recent opinion piece by Post in the Journal of the American Medical Association, one of the most influential journals in medicine. In his piece, Post draws an analogy to cancer in formulating his plea for a more aggressive approach to the management of bipolar disorder in order to prevent its “malignant transformation.”

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Preventing the Malignant Transformation of Bipolar Disorder

Cited by 25 publications

References 9 publications

Bipolar disorder and depression in early adulthood and long‐term employment, income, and educational attainment: A nationwide cohort study of 2,390,127 individuals

Bipolar disorder and depression in early adulthood and long‐term employment, income, and educational attainment: A nationwide cohort study of 2,390,127 individuals

Myriad of implications of acetyl- l -carnitine deficits in depression

Bipolar disorder, lithium, and the task ahead

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