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Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

Published online by Cambridge University Press:  10 April 2014

A. Peters ,
L. G. Sylvia ,
P. V. da Silva Magalhães ,
D. J. Miklowitz ,
E. Frank ,
M. W. Otto ,
N. S. Hansen ,
D. D. Dougherty ,
M. Berk  and
A. A. Nierenberg
...Show all authors
A. Peters
Affiliation:
University of Illinois at Chicago, Chicago, IL, USA
L. G. Sylvia
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
P. V. da Silva Magalhães
Affiliation:
Universidade Federal de Rio Grande de Sul, Porte Alegre, Brazil
D. J. Miklowitz
Affiliation:
UCLA School of Medicine, Los Angeles, CA, USA
E. Frank
Affiliation:
University of Pittsburgh, Pittsburgh, PA, USA
M. W. Otto
Affiliation:
Boston University, Boston, MA, USA
N. S. Hansen
Affiliation:
Massachusetts General Hospital, Boston, MA, USA
D. D. Dougherty
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
M. Berk
Affiliation:
Deakin University, Melbourne, Australia University of Melbourne, Melbourne, Australia
A. A. Nierenberg
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
T. Deckersbach*
Affiliation:
Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
*
* Address for correspondence: T. Deckersbach, Ph.D., Massachusetts General Hospital, Building 149, 13th Street, 2nd Floor, Charlestown, MA 02129, USA. (Email: tdeckersbach@partners.org)
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Abstract

Background.

The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy.

Method.

Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments.

Results.

Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10–20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes.

Conclusions.

Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.

Keywords

Bipolar disordermood episodespsychotherapystaging
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 16 , December 2014 , pp. 3455 - 3467
Copyright
Copyright © Cambridge University Press 2014 

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