Gender and Depressive Symptoms in 711 Patients With Bipolar Disorder Evaluated Prospectively in the Stanley Foundation Bipolar Treatment Outcome Network

Department of Psychiatry, Ludwig-Maximilians-University of Munich, München, Bavaria, Germany
American Journal of Psychiatry (Impact Factor: 12.3). 03/2010; 167(6):708-15. DOI: 10.1176/appi.ajp.2009.09010105
Source: PubMed

ABSTRACT The authors assessed gender differences in the proportion of clinical visits spent depressed, manic, or euthymic in patients with bipolar disorder.
Data were analyzed from 711 patients with bipolar I or II disorder who were followed prospectively over 7 years (13,191 visits). The main outcome measures were the presence of symptoms of depression or of hypomania or mania, measured by the Inventory of Depressive Symptomatology and the Young Mania Rating Scale. Data were analyzed using three separate repeated-measures regressions with a logistic link function to model the probability that an individual was depressed, manic, or euthymic. The models controlled for bipolar I or bipolar II diagnosis, rapid cycling, age, time in the study, comorbid anxiety disorders, and comorbid substance use disorders.
In approximately half of visits, patients had depressive, manic, or hypomanic symptoms. The likelihood of having depressive symptoms was significantly greater for women than for men. This was accounted for by higher rates in women of rapid cycling and anxiety disorders, each of which was associated with increased rates of depression. All patient groups showed an increase in number of euthymic visits and a decrease in number of visits with depressive and manic symptoms with increased time in study.
Bipolar patients spend a substantial proportion of their time ill. Significant gender differences exist, with women spending a greater proportion of their visits in the depressive pole. This finding appears to be related to the corresponding differences in rates of rapid cycling and anxiety disorders.

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Available from: Heinz Grunze, Sep 11, 2015
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    • "Women of reproductive age were more prone to depression in the Stanley Foundation bipolar disorder cohort (Altshuler et al., 2010), but not in the STEP-BD study (Baldassano et al., 2005). In addition, the comorbidity of BD with illnesses that present with gender differences (including anxiety disorders (Baldassano et al., 2005; Baldassano, 2006; Altshuler et al., 2010; Saunders et al., 2012), migraine (Fasmer, 2001; Low et al., 2007; Baptista et al., 2012; Saunders et al., 2014), and eating disorders (Baldassano et al., 2005; Baldassano, 2006; Jen et al., 2013)) has been shown to cause more depression and worse course of illness in BD. Women in the general population report more insomnia than men during the reproductive years at a ratio of 1.4:1.0, "
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    ABSTRACT: Sleep disturbance is bi-directionally related to mood de-stabilization in bipolar disorder (BD), and sleep quality differs in men and women. We aimed to determine whether perception of poor sleep quality would have a different effect on mood outcome in men versus women. We assessed association between sleep quality (Pittsburgh Sleep Quality Index (PSQI)) at study intake and mood outcome over 2 years in subjects from the Prechter Longitudinal Study of Bipolar Disorder (N=216; 29.6% males). The main outcome measure was the severity, variability, and frequency of mood episodes measured by self-report over 2 years of follow-up. Multivariable linear regression models stratified by sex examined the relationship between PSQI with mood outcomes, while age, stressful life events, mood state and neuroticism at baseline were controlled. In women, poor sleep quality at baseline predicted increased severity (B=0.28, p<0.001) and frequency of episodes (B=0.32, p<0.001) of depression, and poor sleep quality was a stronger predictor than baseline depression; poor sleep quality predicted increased severity (B=0.19, p<0.05) and variability (B=0.20, p<0.05) of mania, and frequency of mixed episodes (B=0.27, p<0.01). In men, baseline depression and neuroticism were stronger predictors of mood outcome compared to poor sleep quality. We measured perception of sleep quality, but not objective changes in sleep. In a longitudinal study of BD, women reported poorer perceived sleep quality than men, and poor sleep quality predicted worse mood outcome in BD. Clinicians should be sensitive to addressing sleep complaints in women with BD early in treatment to improve outcome in BD. Copyright © 2015. Published by Elsevier B.V.
    Journal of Affective Disorders 04/2015; 180:90-96. DOI:10.1016/j.jad.2015.03.048 · 3.38 Impact Factor
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    • "This is in line with a recent study in Norway that found a male: female ratio of 1:2 (Schweder et al., 2011). Even though women with bipolar disorder have a greater likelihood of having subsyndromal depressive symptoms (Altshuler et al., 2010), those are not a clinical indication for ECT and are unlikely to explain the gender difference. One explanation could be that women with depression may undergo fewer pharmacological trials before being referred to ECT (Bloch et al., 2005), but this contradicts our finding that women are prescribed more antidepressants than men. "
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    ABSTRACT: BACKGROUND: Gender differences in treatment that are not supported by empirical evidence have been reported in several areas of medicine. Here, the aim was to evaluate potential gender differences in the treatment for bipolar disorder. METHODS: Data was collected from the Swedish National Quality Assurance Register for bipolar disorder (BipoläR). Baseline registrations from the period 2004-2011 of 7354 patients were analyzed. Multiple logistic regression analysis was used to study the impact of gender on interventions. RESULTS: Women were more often treated with antidepressants, lamotrigine, electroconvulsive therapy, benzodiazepines, and psychotherapy. Men were more often treated with lithium. There were no gender differences in treatment with mood stabilizers as a group, neuroleptics, or valproate. Subgroup analyses revealed that ECT was more common in women only in the bipolar I subgroup. Contrariwise, lamotrigine was more common in women only in the bipolar II subgroup. LIMITATIONS: As BipoläR contains data on outpatient treatment of persons with bipolar disorder in Sweden, it is unclear if these findings translate to inpatient care and to outpatient treatment in other countries. CONCLUSIONS: Men and women with bipolar disorder receive different treatments in routine clinical settings in Sweden. Gender differences in level of functioning, bipolar subtype, or severity of bipolar disorder could not explain the higher prevalence of pharmacological treatment, electroconvulsive therapy, and psychotherapy in women. Our results suggest that clinicians׳ treatment decisions are to some extent unduly influenced by patients׳ gender.
    Journal of Affective Disorders 12/2014; 174C:303-309. DOI:10.1016/j.jad.2014.11.058 · 3.38 Impact Factor
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    • "However, the patients with bipolar disorder are more likely to have the comorbidities of anxiety, substance use disorder [9] and personality disorder [10] which complicate the treatment and may be associated with a higher recurrence rate [11] and poor prognosis [12-15]. In addition, the different subtypes (bipolar I, II or rapid cycling) [16-18] of bipolar disorder or the gender of the patient [19,20] may lead to different responses to treatments. Therefore, acute and prophylactic pharmacological treatment for bipolar depression is challenging for clinicians as only a few agents have been demonstrated to be efficacious. "
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    ABSTRACT: Bipolar disorder is a highly recurrent disease and has great impact on the function of patients. Depressive symptoms consist of more than 50% of life time during the illness and may lead to self harm or suicidal behaviors. Little is known about the antidepressant effects of olanzapine, an atypical antipsychotic, as monotherapy despite its indication for preventing manic episodes. In contrast, lamotrigine, a mood stabilizer, has been proven to be effective in preventing depression in patients with bipolar disorder. However, no studies have compared the efficacy between lamotrigine and olanzapine in the maintenance treatment of bipolar disorder. This enriched naturalistic study was implemented to assess the effectiveness of olanzapine and lamotrigine as monotherapy in the prevention of recurrence of bipolar disorder. Patients with bipolar disorder in a euthymic state (Young’s Mania Rating Scale (YMRS) score <12, and 21-item Hamilton Depression Rating Scale (HAM-D) score <7) for at least two months, having already received either olanzapine or lamotrigine as the maintenance treatment were recruited. The patients maintained with olanzapine (n = 22) were applied to olanzapine group whereas those maintained with lamotrigine (n = 29) were applied to lamotrigine group. They were followed up for 12 months. Differences in the efficacy between olanzapine and lamotrigine in recurrence prevention were analyzed. The Kaplan-Meier method was used to generate time-to-recurrence curves, and differences between the two groups were compared using the log-rank test. Olanzapine had a significantly lower recurrence rate of depressive episodes than lamotrigine (20.0% vs. 57.7%, χ2 = 6.62, p = .010). However, olanzapine and lamotrigine had similar mania (15.0% vs. 0%, χ2 = 4.17, p = .075, Fisher’s exact test) and any mood episode (35.0% vs. 57.7%, χ2 = 2.33, p = .127) recurrence rates. Olanzapine was significantly superior to lamotrigine in the time to recurrence of depressive episodes (χ2 = 4.55, df = 1, p = .033), but there was no difference in the time to recurrence of any mood episode (χ2 = 1.68, df = 1, p = .195). This prospective naturalistic study suggests that olanzapine is more effective than lamotrigine in the prevention of depressive episodes in patients with bipolar disorder. Future large-scale randomized studies are warranted to validate our results. Trial registration ID NCT01864551.
    BMC Psychiatry 05/2014; 14(1):145. DOI:10.1186/1471-244X-14-145 · 2.21 Impact Factor
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