Predictors of recurrence during long-term treatment of bipolar I and II disorders. A 4 year prospective naturalistic study

BACKGROUND

Despite the large number of treatments available for bipolar disorder (BD), more than one half of patients have a recurrence within 2 years, and over 90% experience at least one additional affective episode during their lifetime.

METHODS

The aim of this study was to test the impact of a number of demographic and clinical features on the risk to recurrence in a real- word representative sample of 266 outpatients with BD-I or II treated in a naturalistic setting during a 4-years-follow-up period.

RESULTS

We found that the number of episodes per year after study entry, compared to the number of episodes per year before study entry,significantly decreased and that about one third of patients had no recurrences during the observation period. The length of follow-up and the number of previous episodes, mainly depressive, predicted the risk of recurrence, while female gender, higher age at intake, and a higher frequency of past mixed episodes predicted a higher frequency of recurrences.

LIMITATIONS

The study had some limitations to consider: i.e. the risk of poor reliability of information on the previous course of illness or the naturalistic treatment during the follow-up.

CONCLUSIONS

Our study suggests that (a) an evidence-based long-term treatment, with regular follow-up visits could improve the course of disease and prognosis; (b) clinicians should carefully consider the presence of a high number of mixed episodes, to provide more targeted treatment strategies; (c) an appropriate use of antidepressants in selected patients did not worsen the course of illness.

Real-world Effectiveness and Tolerability of Lurasidone in Outpatients with Bipolar DisorderII- A 24 week retrospective study (RETLO-BDIIstudy)

OBJECTIVES

We conducted a retrospective study to investigate the efficacy and safety of lurasidone (LUR) in outpatients with depressive episodes of bipolar disorder II (BD2) in real world setting.

METHODS

We retrospectively analyzed the clinical data obtained from the medical records of the Horikoshi Psychosomatic Clinic between February 2020 and April 2022. A total of 78 patients with BD2 who experienced a depressive episode were included in this study. The primary outcome was the mean change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to 8 weeks (W). The secondary outcome was the mean change in the MADRS score from baseline to 2, 4, and 12 W. Discontinuation and adverse event rates were measured after 24 W.

RESULTS

After starting LUR, the mean total score of the MADRS significantly decreased at 8 W (-11.8 ± 8.26, P < 0.0001). Patients with BD2 who underwent the treatment with LUR showed significantly great improvement at 2 W (-8.38 ± 8.75, P< 0.0001), 4 W (-11.2 ± 8.36 P < 0.0001), and 24 W (-11.6 ± 7.29, P < 0.0001). The discontinuation and adverse event rates in patients who underwent LUR were 23.1 % and 37.2 %, respectively.

CONCLUSION

LUR significantly improved depressive symptoms in patients with BD2 at 8 W. Moreover, treatment with LUR resulted in early improvement at 2 W and efficacy for 24 weeks. In summary, LUR demonstrated effectiveness and safety in acute depressive episodes of BD2, including mid-term efficacy in real-world clinical settings.