Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Bipolar Disord. 2019 Jun;21(4):350-360. doi: 10.1111/bdi.12715. Epub 2018 Dec 1.
Depressive episodes are often prevalent among patients with bipolar disorder, but little is known regarding the differential patterns of development over time. We aimed to determine and characterize trajectories of depressive symptoms among adults with bipolar disorder during 6 months of systematic treatment.
The pragmatic clinical trial, Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (CHOICE), randomized 482 outpatients with bipolar disorder to lithium or quetiapine. Depressive symptoms were rated at up to 9 visits using the Montgomery-Asberg Depression Rating Scale (MADRS). Growth mixture modeling was utilized to identify trajectories and multinomial regression analysis estimated associations with potential predictors.
Four distinct trajectories of depressive symptoms were identified. The responding class (60.3%) with a rapid reduction and subsequent low level; the partial-responding class (18.4%) with an initial reduction followed by an increase during the remaining weeks; the fluctuating class (11.6%) with a fluctuation in depressive symptoms; and the non-responding class (9.7%) with sustained moderate-severe depressive symptoms. Bipolar type I predicted membership of the non-responding class and randomization to quetiapine predicted membership of either the responding or the non-responding class.
Approximately 30% experienced a partial or fluctuating course, and almost 10% had a chronic course with moderate-severe depression during 6 months. Patients diagnosed with bipolar type 1 had higher risk of being categorized into a class with a worse outcome. While no differences in average overall outcomes occurred between the lithium and quetiapine groups, trajectory analysis revealed that the lithium group had more variable courses.
双相障碍患者常出现抑郁发作，但对于随时间推移的不同发展模式知之甚少。我们旨在确定并描述在 6 个月系统治疗期间，成人双相障碍患者的抑郁症状轨迹。
实用临床试验，双相临床健康结果比较有效性倡议（CHOICE），将 482 名门诊双相障碍患者随机分为锂或喹硫平组。使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）在最多 9 次就诊时评定抑郁症状。采用增长混合模型确定轨迹，使用多项回归分析估计与潜在预测因子的关联。
确定了 4 种不同的抑郁症状轨迹。快速减少和随后低水平的反应类（60.3%）；初始减少随后剩余周内增加的部分反应类（18.4%）；抑郁症状波动的波动类（11.6%）；以及持续中度至重度抑郁症状的无反应类（9.7%）。双相 I 型预测了无反应类的成员资格，而随机分组到喹硫平预测了反应类或无反应类的成员资格。
大约 30%的患者经历了部分或波动的病程，近 10%的患者在 6 个月内出现了中度至重度抑郁症的慢性病程。诊断为双相 1 型的患者有更高的风险归入预后较差的类别。虽然锂和喹硫平组之间的总体平均结局无差异，但轨迹分析显示锂组的病程变化更大。
