Skip to main content Accessibility help
×
Home

Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM)

  • Kesavan Muralidharan (a1), Ivan J. Torres (a2), Leonardo E. Silveira (a3), Jan-Marie Kozicky (a2), Joana Bücker (a4), Nadeesha Fernando (a2) and Lakshmi N. Yatham (a2)...

Abstract

Background

Although manic episodes reportedly contribute to cognitive deficits in bipolar I disorder, the contribution of depressive episodes is poorly researched.

Aims

We investigated the impact of depressive episodes on cognitive function early in the course of bipolar I disorder.

Method

A total of 68 patients and 38 controls from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM) first-episode mania programme were examined. We conducted (a) a cross-sectional analysis of the impact of prior depressive episodes on baseline cognitive function and (b) a prospective analysis assessing the contribution of depression recurrence within 1 year following a first episode of mania on cognitive functioning.

Results

The cross-sectional analysis showed no significant differences between patients with past depressive episodes compared with those without, on overall or individual domains of cognitive function (all P>0.09). The prospective analysis failed to reveal a significant group×time interaction for cognitive decline from baseline to 1 year (P = 0.99) in patients with a recurrence of depressive episodes compared with those with no recurrence. However, impaired verbal memory at baseline was associated with a depression recurrence within 1 year.

Conclusions

Although deficits in all domains of cognitive function are seen in patients early in the course of bipolar disorder, depressive episodes do not confer additional burden on cognitive function. However, poorer verbal memory may serve as a marker for increased susceptibility to depression recurrence early in the course of illness.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM)
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM)
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM)
      Available formats
      ×

Copyright

Corresponding author

Dr Lakshmi N. Yatham, Professor of Psychiatry, Department of Psychiatry, University of British Columbia, Regional Head, Vancouver Coastal Health Authority/Providence Healthcare, 2255 Wesbrook Mall, Vancouver, BC, Canada V6T 2A1. Email: yatham@mail.ubc.ca

Footnotes

Hide All

Declaration of interest

L.N.Y. has received research grants from or is a speaker/on advisory boards for AstraZeneca, Bristol-Myers Squibb, Canadian Institutes of Health Research, Canadian Network for Mood and Anxiety Treatments, Eli Lilly & Co, Forest, GlaxoSmithKline, Janssen, Lundbeck, Michael Smith Foundation for Health Research, Novartis, Otsuka, Pfizer, Ranbaxy, Servier, and the Stanley Foundation. J.B. and L.E.S. have received a scholarship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

Footnotes

References

Hide All
1 Gruber, S, Rathgeber, K, Bräunig, P, Gauggel, S. Stability and course of neuropsychological deficits in manic and depressed bipolar patients compared to patients with major depression. J Affect Disord 2007; 104: 6171.
2 Malhi, GS, Ivanovski, B, Hadzi-Pavlovic, D, Mitchell, PB, Vieta, E, Sachdev, P. Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia. Bipolar Disord 2007; 9: 114–25.
3 Arts, B, Jabben, N, Krabbendam, L, van Os, J. Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychol Med 2008; 38: 771–85.
4 Torres, IJ, Boudreau, VG, Yatham, LN. Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl 2007; 116: 1726.
5 Depp, C, Mausbach, BT, Harmell, AL, Savla, GN, Bowie, CR, Harvey, PD, et al. Meta-analysis of the association between cognitive abilities and everyday functioning in bipolar disorder. Bipolar Disord 2012; 14: 217–26.
6 Torres, IJ, DeFreitas, VG, DeFreitas, CM, Kauer-Sant'Anna, M, Bond, DJ, Honer, WG, et al. Neurocognitive functioning in patients with bipolar I disorder recently recovered from a first manic episode. J Clin Psychiatry 2010; 71: 1234–42.
7 Hellvin, T, Sundet, K, Simonsen, C, Aminoff, SR, Lagerberg, TV, Andreassen, OA, et al. Neurocognitive functioning in patients recently diagnosed with bipolar disorder. Bipolar Disord 2012; 14: 227–38.
8 Robinson, LJ, Ferrier, IN. Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence. Bipolar Disord 2006; 8: 103–16.
9 Kessing, LV. Cognitive impairment in the euthymic phase of affective disorder. Psychol Med 1998; 28: 1027–38.
10 Clark, L, Iversen, SD, Goodwin, GM. Sustained attention deficit in bipolar disorder. Br J Psychiatry 2002; 180: 313–9.
11 Zubieta, JK, Huguelet, P, O'Neil, RL, Giordani, BJ. Cognitive function in euthymic bipolar I disorder. Psychiatry Res 2001; 102: 920.
12 Deckersbach, T, Savage, CR, Reilly-Harrington, N, Clark, L, Sachs, G, Rauch, SL. Episodic memory impairment in bipolar disorder and obsessive-compulsive disorder: the role of memory strategies. Bipolar Disord 2004; 6: 233–44.
13 Deckersbach, T, McMurrich, S, Ogutha, J, Savage, CR, Sachs, G, Rauch, SL. Characteristics of non-verbal memory impairment in bipolar disorder: the role of encoding strategies. Psychol Med 2004; 34: 823–32.
14 Thompson, JM, Gallagher, P, Hughes, JH, Watson, S, Gray, JM, Ferrier, IN, et al. Neurocognitive impairment in euthymic patients with bipolar affective disorder. Br J Psychiatry 2005; 186: 3240.
15 Cavanagh, JTO, van Beck, M, Muir, W, Blackwood, DHR. Case–control study of neurocognitive function in euthymic patients with bipolar disorder: an association with mania. Br J Psychiatry 2002; 180: 320–6.
16 Martínez-Arán, A, Vieta, E, Colom, F, Torrent, C, Sánchez-Moreno, J, Reinares, M, et al. Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 2004; 6: 224–32.
17 Rubinsztein, JS, Michael, A, Paykel, ES, Sahakian, BJ. Cognitive impairment in remission in bipolar affective disorder. Psychol Med 2000; 30: 1025–36.
18 van Gorp, WG, Altshuler, L, Theberge, DC, Wilkins, J, Dixon, W. Cognitive impairment in euthymic bipolar patients with and without prior alcohol dependence. A preliminary study. Arch Gen Psychiatry 1998; 55: 41–6.
19 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn, Text Revision) (DSM-IV-TR). APA, 2000.
20 Yatham, LN, Kauer-Sant'Anna, M, Bond, DJ, Lam, RW, Torres, I. Course and outcome after the first manic episode in patients with bipolar disorder: prospective 12-month data from the Systematic Treatment Optimization Program For Early Mania project. Can J Psychiatry 2009; 54: 105–12.
21 Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al. The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 (suppl 20): 2233.
22 Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978; 133: 429–35.
23 Williams, JBW, Link, MJ, Rosenthal, NE, Terman, M. Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (SIGH-SAD). New York State Psychiatric Institute, 1988.
24 Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–76.
25 Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J. The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1979; 33: 6671.
26 Yatham, LN, Kennedy, SH, O'Donovan, C, Parikh, S, MacQueen, G, McIntyre, R, et al. Canadian Network for Mood and Anxiety Treatments. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord 2005; 7 (suppl 3): 569.
27 Yatham, LN, Kennedy, SH, O'Donovan, C, Parikh, SV, MacQueen, G, McIntyre, RS, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: update 2007. Bipolar Disord 2006; 8: 721–39.
28 Yatham, LN, Kennedy, SH, Schaffer, A, Parikh, SV, Beaulieu, S, O'Donovan, C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disord (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disord 2009; 11: 225–55.
29 Robbins, TW, James, M, Owen, AM, Sahakian, BJ, McInnes, L, Rabbitt, P. Cambridge neuropsychological test automated battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia 1994; 5: 266–81.
30 Sweeney, JA, Kmiec, JA, Kupfer, DJ. Neuropsychologic impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery. Biol Psychiatry 2000; 48: 674–84.
31 Olley, AL, Malhi, GS, Bachelor, J, Cahill, CM, Mitchell, PB, Berk, M. Executive functioning and theory of mind in euthymic bipolar disorder. Bipolar Disord 2005; 7 (suppl 5): 4352.
32 Nuechterlein, KH, Green, MF, Kern, RS, Baade, LE, Barch, DM, Cohen, JD, et al. The MATRICS consensus cognitive battery, part 1: Test selection, reliability, and validity. Am J Psychiatry 2008; 165: 203–13.
33 Yatham, LN, Torres, IJ, Malhi, GS, Frangou, S, Glahn, DC, Bearden, CE, et al. The International Society for Bipolar Disord-Battery for Assessment of Neurocognition (ISBD-BANC). Bipolar Disord 2010; 12: 351–63.
34 Burdick, KE, Goldberg, TE, Cornblatt, BA, Keefe, RS, Gopin, CB, Derosse, P, et al. The MATRICS consensus cognitive battery in patients with bipolar I disorder. Neuropsychopharmacology 2011; 36: 1587–92.
35 Torres, IJ, Kozicky, J, Popuri, S, Bond, DJ, Honer, WG, Lam, RW, et al. 12-month longitudinal cognitive functioning in patients recently diagnosed with bipolar disorder. Bipolar Disord 2013; 25 Nov, epub ahead of print.
36 Nehra, R, Chakrabarti, S, Pradhan, BK, Khehra, N. Comparison of cognitive functions between first- and multi-episode bipolar affective disorders. J Affect Disord 2006; 93: 185–92.
37 Gruber, SA, Rosso, IM, Yurgelun-Todd, D. Neuropsychological performance predicts clinical recovery in bipolar patients. J Affect Disord 2008; 105: 253–60.
38 Lee, RSC, Hermens, DF, Porter, M, Redoblado-Hodge, MA. A meta-analysis of cognitive deficits in first-episode major depressive disorder. J Affect Disord 2012; 140: 113–24.
39 Wekking, EM, Bockting, CLH, Koeter, MWJ, Schene, AH. Cognitive functioning in euthymic recurrently depressed patients: relationship with future relapses and prior course of disease. J Affect Disord 2012; 141: 300–7.
40 Bora, E, Yucel, M, Pantelis, C. Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. J Affect Disord 2009; 113: 120.
41 Hasselbalch, BJ, Knorr, U, Hasselbalch, SG, Gade, A, Kessing, LV. The cumulative load of depressive illness is associated with cognitive function in the remitted state of unipolar depressive disorder. Eur Psychiatry 2012; 28: 349–55.
42 MacQueen, G, Frodl, T. The hippocampus in major depression: evidence for the convergence of the bench and bedside in psychiatric research? Mol Psychiatry 2011; 16: 252–64.
43 Gurden, H, Tassin, JP, Jay, TM. Integrity of the mesocortical dopaminergic system is necessary for complete expression of in vivo hippocampal-prefrontal cortex long-term potentiation. Neuroscience 1999; 94: 1019–27.
44 McKinnon, MC, Yucel, K, Nazarov, A, MacQueen, GM. A meta-analysis examining clinical predictors of hippocampal volume in patients with major depressive disorder. J Psychiatry Neurosci 2009; 34: 4154.
45 Rao, U, Chen, LA, Bidesi, AS, Shad, MU, Thomas, MA, Hammen, CL. Hippocampal changes associated with early-life adversity and vulnerability to depression. Biol Psychiatry 2010; 67: 357–64.
46 Frey, BN, Andreazza, AC, Nery, FG, Martins, MR, Quevedo, J, Soares, JC, et al. The role of hippocampus in the pathophysiology of bipolar disorder. Behav Pharmacol 2007; 18: 419–30.
47 Chepenik, LG, Wang, F, Spencer, L, Spann, M, Kalmar, JH, Womer, F, et al. Structure-function associations in hippocampus in bipolar disorder. Biol Psychol 2012; 90: 1822.
48 Gourovitch, ML, Torrey, EF, Gold, JM, Randolph, C, Weinberger, DR, Goldberg, TE. Neuropsychological performance of monozygotic twins discordant for bipolar disorder. Biol Psychiatry 1999; 45: 639–46.
49 Kéri, S, Kelemen, O, Benedek, G, Janka, Z. Different trait markers for schizophrenia and bipolar disorder: a neurocognitive approach. Psychol Med 2001; 31: 915–22.
50 Balanzá-Martínez, V, Rubio, C, Selva-Vera, G, Martinez-Aran, A, Sánchez-Moreno, J, Salazar-Fraile, J, et al. Neurocognitive endophenotypes (endophenocognitypes) from studies of relatives of bipolar disorder subjects: a systematic review. Neurosci Biobehav Rev 2008; 32: 1426–38.
51 Hasselbalch, BJ, Knorr, U, Kessing, LV. Cognitive impairment in the remitted state of unipolar depressive disorder: a systematic review. J Affect Disord 2011; 134: 2031.
52 Dias, VV, Balanzá-Martinez, V, Soeiro-de-Souza, MG, Moreno, RA, Figueira, ML, Machado-Vieira, R, et al. Pharmacological approaches in bipolar disorder and the impact on cognition: a critical overview. Acta Psychiatr Scand 2012; 126: 315–31.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Impact of depressive episodes on cognitive deficits in early bipolar disorder: data from the Systematic Treatment Optimization Programme for Early Mania (STOP-EM)

  • Kesavan Muralidharan (a1), Ivan J. Torres (a2), Leonardo E. Silveira (a3), Jan-Marie Kozicky (a2), Joana Bücker (a4), Nadeesha Fernando (a2) and Lakshmi N. Yatham (a2)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *