Treatment effectiveness and tolerability outcomes that are most important to individuals with bipolar and unipolar depression

Rosenblat, Joshua D.; Simon, Gregory E.; Sachs, Gary S.; Deetz, Ingrid; Doederlein, Allen; DePeralta, Denisse; Dean, Mary Mischka; McIntyre, Roger S.

doi:10.1016/j.jad.2018.09.027

Cited by 64 publications

(48 citation statements)

References 20 publications

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“…Intolerable adverse events are a frequent cause of treatment nonadherence, although events that are often thought of as mild and/or transient by clinicians (e.g. gastrointestinal issues, dry mouth) were reported as the reason for treatment discontinuation for 20-30% of patients who were surveyed by the Depression and Bipolar Support Alliance 115 . Weight gain was reported as the treatment-emergent event most commonly related to medication discontinuation in real-world treatment; lethargy, anxiety, shaking/trembling and suicidal thoughts were also highly associated with treatment discontinuation.…”

Section: Unmet Needsmentioning

confidence: 99%

Bipolar depression: the clinical characteristics and unmet needs of a complex disorder

McIntyre

Calabrese

2019

Current Medical Research and Opinion

Self Cite

102

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Objective: We reviewed important clinical aspects of bipolar depression, a progressive psychiatric condition that is commonly treated in primary care. Bipolar depression is associated with considerable burden of illness, high suicide risk, and greater morbidity and mortality than bipolar mania. Methods: We identified articles relevant to our narrative review using a multistep search of the literature and applying terms that were relevant to bipolar depression or bipolar disorder. Results: Bipolar depression accounts for the majority of time spent unwell for patients with bipolar disorder; high rates of morbidity and mortality arise from full symptomatic episodes and interepisode subsyndromal symptoms. Bipolar depression is an important contributor to long-term dysfunction for patients with bipolar disorder due to psychosocial impairment, loss of work productivity and high rates of substance abuse. Missed and delayed diagnosis is prevalent due to overlapping symptoms with unipolar depression and other diagnoses. Medical comorbidities (i.e. cardiovascular disease, hypertension, obesity, metabolic syndrome) and psychiatric comorbidities (i.e. anxiety disorder, personality disorder, eating disorder, attention-deficit/hyperactivity disorder) are common. Currently, only three treatments are FDA-approved for bipolar depression; monotherapy antidepressants are not a recommended treatment option. Conclusions: Bipolar disorder is common among primary care patients presenting with depression; it is often treated exclusively in primary care. Clinicians should be alert for symptoms of bipolar disorder in undiagnosed patients, know what symptoms probabilistically suggest bipolar versus unipolar depression, have expertise in providing ongoing treatment to diagnosed patients, and be knowledgeable about managing common medication-related side effects and comorbidities. Prompt and accurate diagnosis is critical. ARTICLE HISTORY

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Section: Unmet Needsmentioning

confidence: 99%

Bipolar depression: the clinical characteristics and unmet needs of a complex disorder

McIntyre

Calabrese

2019

Current Medical Research and Opinion

Self Cite

102

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“…However, more than 80% of people do not seek treatment in developing countries and only 35–50% in high-income countries receive minimally adequate treatment [2] because of barriers such as high cost, limited valid treatments and diagnosis difficulty. Moreover, the recognized treatments for emotional disorders, namely, pharmacological therapy and psychotherapy, have been criticized for inconsistent clinical outcomes and side effects [3,4]. Given the current limitations in effectiveness of treatment modalities for emotional disorders, the WHO suggested that the most suitable method for reducing the burden caused by these disorders is prevention [5].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Tai Chi Chuan on Negative Emotions in Non-Clinical Populations: A Meta-Analysis and Systematic Review

Zhang

Zou

Chen

et al. 2019

IJERPH

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Tai Chi Chuan (TCC) as a typical mind-body practice has been investigated for its preventive role on negative emotions and has demonstrated its efficacy in healthy populations. However, the results are not consistent. We performed a meta-analysis and systematically evaluated the effect of TCC on selected negative emotions (i.e., anxiety and depression). Fourteen experimental studies from three English-and two Chinese-language databases were evaluated. The results showed that the positive effects of TCC on negative emotions were moderately to largely significant. In addition, although TCC significantly improved negative emotions in both the young adults and the older adults, old adults benefited more from TCC than young adults. These findings suggest that TCC is a worthy complementary non-pharmacological resource towards depression and anxiety and, thus, has great implications for the public health domain.

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“…No information was available about the patient perspective on taking atypical antipsychotics or other psychiatric drugs. Some patients feel uneasy about taking antipsychotics, for reasons including stigma, side effects such as weight gain, experiencing changes to the subjective state, and concerns about long-term use [48][49][50][51]. Financial considerations and the costs of psychiatric drugs were not considered.…”

Section: Limitationsmentioning

confidence: 99%

Association between Adherence with an Atypical Antipsychotic and with Other Psychiatric Drugs in Patients with Bipolar Disorder

Bauer

Glenn²,

Alda

et al. 2020

Pharmacopsychiatry

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Background Using U.S. pharmacy and medical claims, medication adherence patterns of patients with serious mental illness suggest that adherence to atypical antipsychotics may be related to adherence to other prescription drugs. This study investigated whether adherence to an atypical antipsychotic was related to adherence to other prescribed psychiatric drugs using self-reported data from patients with bipolar disorder. Methods Daily self-reported medication data were available from 123 patients with a diagnosis of bipolar disorder receiving treatment as usual who took at least 1 atypical antipsychotic over a 12-week period. Patients took a mean of 4.0±1.7 psychiatric drugs including the antipsychotic. The adherence rate for the atypical antipsychotic was compared to that for other psychiatric drugs to determine if the adherence rate for the atypical antipsychotic differed from that of the other psychiatric drug by at least ±10%. Results Of the 123 patients, 58 (47.2%) had an adherence rate for the atypical antipsychotic that differed from the adherence rate for at least 1 other psychiatric drug by at least±10%, and 65 (52.8%) patients had no difference in adherence rates. The patients with a difference took a larger total number of psychiatric drugs (p<0.001), had a larger daily pill burden (p=0.020) and a lower adherence rate with the atypical antipsychotic (p=0.007), and were more likely to take an antianxiety drug (p<0.001). Conclusion Adherence with an atypical antipsychotic was not useful for estimating adherence to other psychiatric drugs in about half of the patients with bipolar disorder.

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Treatment effectiveness and tolerability outcomes that are most important to individuals with bipolar and unipolar depression

Cited by 64 publications

References 20 publications

Bipolar depression: the clinical characteristics and unmet needs of a complex disorder

Bipolar depression: the clinical characteristics and unmet needs of a complex disorder

The Effect of Tai Chi Chuan on Negative Emotions in Non-Clinical Populations: A Meta-Analysis and Systematic Review

Association between Adherence with an Atypical Antipsychotic and with Other Psychiatric Drugs in Patients with Bipolar Disorder

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