Skip to main content
×
Home
    • Aa
    • Aa

The role of psychosocial stress in the onset and progression of bipolar disorder and its comorbidities: The need for earlier and alternative modes of therapeutic intervention

  • R. M. POST (a1) and G. S. LEVERICH (a2)
Abstract

Psychosocial stress plays an important role at multiple junctures in the onset and course of bipolar disorder. Childhood adversity may be a risk factor for vulnerability to early onset illness, and an array of stressors may be relevant not only to the onset, recurrence, and progression of affective episodes, but the highly prevalent substance abuse comorbidities as well. A substantial group of controlled studies indicate that various cognitive behavioral psychotherapies and psychoeducational approaches may yield better outcomes in bipolar disorder than treatment as usual. Yet these approaches do not appear to be frequently or systematically employed in clinical practice, and this may contribute to the considerable residual morbidity and mortality associated with conventional treatment. Possible practical approaches to reducing this deficit (in an illness that is already underdiagnosed and undertreated even with routine medications) are offered. Without the mobilization of new clinical and public health approaches to earlier and more effective treatment and supportive interventions, bipolar illness will continue to have grave implications for many patients' long-term well being.This article was based on work in the Intramural Program of the NIMH and work in the former Stanley Foundation Bipolar Network. The principal investigators of the Network included L. Altshuler, M. Frye, T. Suppes, S. McElroy, P. Keck, Jr., W. Nolen, R. Kupka, J. Walden, and H. Grunze. We also acknowledge the special contributions of D. Luckenbaugh and S. Perez in data analysis and C. Gavin and H. Brightman in manuscript preparation.

Copyright
Corresponding author
Address correspondence and reprint requests to: Robert M. Post, Biological Psychiatry Branch, Special Volunteer, NIMH, NIH, Building 10, Room 3S239, 10 Center Drive MSC-1272, Bethesda, MD 20892-1272; E-mail: robert.post@speakeasy.net
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

Allen, M. G. (1976). Twin studies of affective illness. Archives of General Psychiatry, 33, 14761478.

Ambelas, A. (1979). Psychologically stressful events in the precipitation of manic episodes. British Journal of Psychiatry, 135, 1521.

Anisman, H., Zaharia, M. D., Meaney, M. J., & Merali, Z. (1998). Do early-life events permanently alter behavioral and hormonal responses to stressors? International Journal of Developmental Neuroscience, 16, 149164.

Barney, L. J., Griffiths, K. M., Jorm, A. F., & Christiensen, H. (2005). Stigma about depression and its impact on help-seeking intentions. Australian and New Zealand Journal of Psychiatry, 40, 5154.

Birmaher, B., Axelson, D., Strober, M., Gill, M. K., Valeri, S., Chiappetta, L., et al. (2006). Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63, 175183.

Boylan, K. R., Bieling, P. J., Marriott, M., Begin, H., Young, L. T., & MacQueen, G. M. (2004). Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder. Journal of Clinical Psychiatry, 65, 11061113.

Brent, D. A., Oquendo, M., Birmaher, B., Greenhill, L., Kolko, D., Stanley, B., et al. (2002). Familial pathways to early-onset suicide attempt: Risk for suicidal behavior in offspring of mood-disordered suicide attempters. Archives of General Psychiatry, 59, 801807.

Brown, G. R., McBride, L., Bauer, M. S., & Williford, W. O. (2005). Impact of childhood abuse on the course of bipolar disorder: A replication study in U.S. veterans. Journal of Affective Disorders, 89, 5767.

Carlson, G. A., Bromet, E. J., & Sievers, S. (2000). Phenomenology and outcome of subjects with early- and adult-onset psychotic mania. American Journal of Psychiatry, 157, 213219.

Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., et al. (2003). Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301, 386389.

Cate Carter, T. D., Mundo, E., Parikh, S. V., & Kennedy, J. L. (2003). Early age at onset as a risk factor for poor outcome of bipolar disorder. Journal of Psychiatric Research, 37, 297303.

Cohen, L. S., Altshuler, L. L., Harlow, B. L., Nonacs, R., Newport, D. J., Viguera, A. C., et al. (2006). Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. Journal of the American Medical Association, 295, 499507.

Cohen, L. S., Nonacs, R. M., Bailey, J. W., Viguera, A. C., Reminick, A. M., Altshuler, L. L., et al. (2004). Relapse of depression during pregnancy following antidepressant discontinuation: A preliminary prospective study. Archives of Women's Mental Health, 7, 217221.

Colom, F., & Lam, D. (2005). Psychoeducation: Improving outcomes in bipolar disorder. European Psychiatry, 20, 359364.

Colom, F., Vieta, E., Reinares, M., Martinez-Aran, A., Torrent, C., Goikolea, J. M., et al. (2003). Psychoeducation efficacy in bipolar disorders: Beyond compliance enhancement. Journal of Clinical Psychiatry, 64, 11011105.

Covington, H. E., III, & Miczek, K. A. (2001). Repeated social-defeat stress, cocaine or morphine. Effects on behavioral sensitization and intravenous cocaine self-administration “binges.” Psychopharmacology (Berlin), 158, 388398.

Das, A. K., Olfson, M., Gameroff, M. J., Pilowsky, D. J., Blanco, C., Feder, A., et al. (2005). Screening for bipolar disorder in a primary care practice. Journal of the American Medical Association, 293, 956963.

Davidson, J. R., Tupler, L. A., Wilson, W. H., & Connor, K. M. (1998). A family study of chronic post-traumatic stress disorder following rape trauma. Journal of Psychiatric Research, 32, 301309.

Engstrom, C., Brandstrom, S., Sigvardsson, S., Cloninger, R., & Nylander, P. O. (2003). Bipolar disorder. II: Personality and age of onset. Bipolar Disorder, 5, 340348.

Ernst, C. L., & Goldberg, J. F. (2004). Clinical features related to age at onset in bipolar disorder. Journal of Affective Disorders, 82, 2127.

Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Conti, S., & Grandi, S. (2004). Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. American Journal of Psychiatry, 161, 18721876.

Francis, D., Diorio, J., Liu, D., & Meaney, M. J. (1999). Nongenomic transmission across generations of maternal behavior and stress responses in the rat. Science, 286, 11551158.

Francis, D. D., Caldji, C., Champagne, F., Plotsky, P. M., & Meaney, M. J. (1999). The role of corticotropin-releasing factor–norepinephrine systems in mediating the effects of early experience on the development of behavioral and endocrine responses to stress. Biological Psychiatry, 46, 11531166.

Frye, M. A., Altshuler, L. L., McElroy, S. L., Suppes, T., Keck, P. E., Denicoff, K., et al. (2003). Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder. American Journal of Psychiatry, 160, 883889.

Frye, M. A., Ketter, T. A., Leverich, G. S., Huggins, T., Lantz, C., Denicoff, K. D., et al. (2000). The increasing use of polypharmacotherapy for refractory mood disorders: 22 years of study. Journal of Clinical Psychiatry, 61, 915.

Garno, J. L., Goldberg, J. F., Ramirez, P. M., & Ritzler, B. A. (2005). Impact of childhood abuse on the clinical course of bipolar disorder. British Journal of Psychiatry, 186, 121125.

Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106, 10711083.

Geller, B., Craney, J. L., Bolhofner, K., Nickelsburg, M. J., Williams, M., & Zimerman, B. (2002). Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype. American Journal of Psychiatry, 159, 927933.

Geller, B., Tillman, R., Craney, J. L., & Bolhofner, K. (2004). Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry, 61, 459467.

Gershon, E. S., Hamovit, J., Guroff, J. J., Dibble, E., Leckman, J. F., Sceery, W., et al. (1982). A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands. Archives of General Psychiatry, 39, 11571167.

Goeders, N.E., & Clampitt, D. M. (2002). Potential role for the hypothalamo–pituitary–adrenal axis in the conditioned reinforcer-induced reinstatement of extinguished cocaine seeking in rats. Psychopharmacology (Berlin), 161, 222232.

Goeders, N. E., & Guerin, G. F. (1994). Non-contingent electric footshock facilitates the acquisition of intravenous cocaine self-administration in rats. Psychopharmacology (Berlin), 114, 6370.

Haney, M., Maccari, S., Le Moal, M., Simon, H., & Piazza, P. V. (1995). Social stress increases the acquisition of cocaine self-administration in male and female rats. Brain Research, 698, 4652.

Harpold, T. L., Wozniak, J., Kwon, A., Gilbert, J., Wood, J., Smith, L., et al. (2005). Examining the association between pediatric bipolar disorder and anxiety disorders in psychiatrically referred children and adolescents. Journal of Affective Disorders, 88, 1926.

Henry, C., Van den, B. D., Bellivier, F., Etain, B., Rouillon, F., & Leboyer, M. (2003). Anxiety disorders in 318 bipolar patients: Prevalence and impact on illness severity and response to mood stabilizer. Journal of Clinical Psychiatry, 64, 331335.

Hinshaw, S. P., & Cicchetti, D. (2000). Stigma and mental disorder: Conceptions of illness, public attitudes, personal disclosure, and social policy. Developmental Psychopathology, 12, 555598.

Hirschfeld, R. M., Cass, A. R., Holt, D. C., & Carlson, C. A. (2005). Screening for bipolar disorder in patients treated for depression in a family medicine clinic. Journal of the American Board of Family Practice, 18, 233239.

Huot, R. L., Thrivikraman, K. V., Meaney, M. J., & Plotsky, P. M. (2001). Development of adult ethanol preference and anxiety as a consequence of neonatal maternal separation in Long Evans rats and reversal with antidepressant treatment. Psychopharmacology (Berlin), 158, 366373.

Kendler, K. S., Myers, J., & Prescott, C. A. (2005). Sex differences in the relationship between social support and risk for major depression: A longitudinal study of opposite-sex twin pairs. American Journal of Psychiatry, 162, 250256.

Kendler, K. S., Thornton, L. M., & Gardner, C. O. (2000). Stressful life events and previous episodes in the etiology of major depression in women: An evaluation of the “kindling” hypothesis. American Journal of Psychiatry, 157, 12431251.

Kendler, K. S., Thornton, L. M., & Gardner, C. O. (2001). Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression. American Journal of Psychiatry, 158, 582586.

Kendler, K. S., Thornton, L. M., & Prescott, C. A. (2001). Gender differences in the rates of exposure to stressful life events and sensitivity to their depressogenic effects. American Journal of Psychiatry, 158, 587593.

Kessing, L. V., Agerbo, E., & Mortensen, P. B. (2004). Major stressful life events and other risk factors for first admission with mania. Bipolar Disorder, 6, 122129.

Kieseppa, T., Partonen, T., Haukka, J., Kaprio, J., & Lonnqvist, J. (2004). High concordance of bipolar I disorder in a nationwide sample of twins. American Journal of Psychiatry, 161, 18141821.

Klein, D. N., Lewinsohn, P. M., Rohde, P., Seeley, J. R., & Olino, T. M. (2005). Psychopathology in the adolescent and young adult offspring of a community sample of mothers and fathers with major depression. Psychological Medicine, 35, 353365.

Krishnan, K. R. (2005). Psychiatric and medical comorbidities of bipolar disorder. Psychosomatic Medicine, 67, 18.

Kupka, R. W., Luckenbaugh, D. A., Post, R. M., Suppes, T., Altshuler, L. L., Keck, P. E., Jr., et al. (2005). Comparison of rapid-cycling and non-rapid-cycling bipolar disorder based on prospective mood ratings in 539 outpatients. American Journal of Psychiatry, 162, 12731280.

Lapalme, M., Hodgins, S., & LaRoche, C. (1997). Children of parents with bipolar disorder: A metaanalysis of risk for mental disorders. Canadian Journal of Psychiatry, 42, 623631.

Leverich, G. S., Altshuler, L. L., Frye, M. A., Suppes, T., Keck, P. E., McElroy, S. L., et al. (2003). Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. Journal of Clinical Psychiatry, 64, 506515.

Leverich, G. S., McElroy, S. L., Suppes, T., Keck, P. E., Jr., Denicoff, K. D., Nolen, W. A., et al. (2002). Early physical and sexual abuse associated with an adverse course of bipolar illness. Biological Psychiatry, 51, 288297.

Leverich, G. S., Perez, S., Luckenbaugh, D. A., & Post, R. M. (2002). Early psychosocial stressors: Relationship to suicidality and course of bipolar illness. Clinical Neuroscience Research, 2, 161170.

Levine, S., Huchton, D. M., Wiener, S. G., & Rosenfeld, P. (1991). Time course of the effect of maternal deprivation on the hypothalamic–pituitary–adrenal axis in the infant rat. Development and Psychobiology, 24, 547558.

Mann, J. J., Bortinger, J., Oquendo, M. A., Currier, D., Li, S., & Brent, D. A. (2005). Family history of suicidal behavior and mood disorders in probands with mood disorders. American Journal of Psychiatry, 162, 16721679.

McElroy, S. L., Altshuler, L. L., Suppes, T., Keck, P. E., Frye, M. A., Denicoff, K. D., et al. (2001). Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder. American Journal of Psychiatry, 158, 420426.

Meaney, M. J., Aitken, D. H., Van Berkel, C., Bhatnagar, S., & Sapolsky, R. M. (1988). Effect of neonatal handling on age-related impairments associated with the hippocampus. Science, 239, 766768.

Meaney, M. J., Brake, W., & Gratton, A. (2002). Environmental regulation of the development of mesolimbic dopamine systems: A neurobiological mechanism for vulnerability to drug abuse? Psychoneuroendocrinology, 27, 127138.

Miklowitz, D. J., George, E. L., Richards, J. A., Simoneau, T. L., & Suddath, R. L. (2003). A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Archives of General Psychiatry, 60, 904912.

Miklowitz, D. J., Richards, J. A., George, E. L., Frank, E., Suddath, R. L., Powell, K. B., et al. (2003). Integrated family and individual therapy for bipolar disorder: Results of a treatment development study. Journal of Clinical Psychiatry, 64, 182191.

Mishkin, M., & Appenzeller, T. (1987). The anatomy of memory. Scientific American, 256, 8089.

Nolen, W. A., Luckenbaugh, D. A., Altshuler, L. L., Suppes, T., McElroy, S. L., Frye, M. A., et al. (2004). Correlates of 1-year prospective outcome in bipolar disorder: Results from the Stanley Foundation Bipolar Network. American Journal of Psychiatry, 161, 14471454.

O'Brien, C. P., Childress, A. R., McLellan, A. T., & Ehrman, R. (1992). Classical conditioning in drug-dependent humans. Annals of the New York Academy of Sciences, 654, 400415.

Olds, D. L., Henderson, C. R., Jr., Kitzman, H. J., Eckenrode, J. J., Cole, R. E., & Tatelbaum, R.C. (1999). Prenatal and infancy home visitation by nurses: Recent findings. Future of Children, 9, 4465.

Othman, S., Bailly, D., Bouden, A., Rufo, M., & Halayem, M. B. (2005). Bipolar disorders in children and adolescents: A clinical study from 50 cases. Annales Medico-Psychologiques, 163, 138146.

Otto, M. W., & Miklowitz, D. J. (2004). The role and impact of psychotherapy in the management of bipolar disorder. CNS Spectrum, 9, 2732.

Otto, M. W., Reilly-Harrington, N., & Sachs, G. S. (2003). Psychoeducational and cognitive–behavioral strategies in the management of bipolar disorder. Journal of Affective Disorders, 73, 171181.

Pavuluri, M. N., Graczyk, P. A., Henry, D. B., Carbray, J. A., Heidenreich, J., & Miklowitz, D. J. (2004). Child- and family-focused cognitive–behavioral therapy for pediatric bipolar disorder: Development and preliminary results. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 528537.

Payne, J. L., Potash, J. B., & DePaulo, J. R., Jr. (2005). Recent findings on the genetic basis of bipolar disorder. Psychiatric Clinics of North America, 28, 481498.

Perlis, R. H., Miyahara, S., Marangell, L. B., Wisniewski, S. R., Ostacher, M., DelBello, M. P., et al. (2004). Long-term implications of early onset in bipolar disorder: Data from the first 1000 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Biological Psychiatry, 55, 875881.

Plotsky, P. M., & Meaney, M. J. (1993). Early, postnatal experience alters hypothalamic corticotropin-releasing factor (CRF) mRNA, median eminence CRF content and stress-induced release in adult rats. Brain Research. Molecular Brain Research, 18, 195200.

Plotsky, P. M., Thrivikraman, K. V., Nemeroff, C. B., Caldji, C., Sharma, S., & Meaney, M. J. (2005). Long-term consequences of neonatal rearing on central corticotropin-releasing factor systems in adult male rat offspring. Neuropsychopharmacology, 30, 21922204.

Post, R. M. (2004a). Differing psychotropic profiles of the anticonvulsants in bipolar and other psychiatric disorders. Clinical Neuoscience Research, 4, 930.

Post, R. M. (2004c). The status of the sensitization/kindling hypothesis of bipolar disorder. Current Psychosis and Therapeutics Reports, 2, 135141.

Post, R. M. (2005). Adjunctive strategies in the treatment of refractory bipolar depression: Clinician options in the absence of a systematic database. Expert Opinion of Pharmacotherapy, 6, 531546.

Post, R. M., Denicoff, K. D., Leverich, G. S., Altshuler, L. L., Frye, M. A., Suppes, T. M., et al. (2003). Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method. Journal of Clinical Psychiatry, 64, 680690.

Post, R. M., & Kowatch, R. A. (2006). The heath care crisis of childhood onset bipolar illness: Some recommendations for its amelioration. Journal of Clinical Psychiatry, 67, 115125.

Post, R. M., Leverich, G. S., Xing, G., & Weiss, R. B. (2001). Developmental vulnerabilities to the onset and course of bipolar disorder. Developmental Psychopathology, 13, 581598.

Post, R. M., Speer, A. M., Hough, C. J., & Xing, G. (2003). Neurobiology of bipolar illness: Implications for future study and therapeutics. Annals of Clinical Psychiatry, 15, 8594.

Post, R. M., Weiss, S. R. B., Leverich, G. S., Smith, M., & Zhang, L. X. (2001). Sensitization and kindling-like phenomena in bipolar disorder: Implications for psychopharmacology. Clinical Neuroscience Research, 1, 6981.

Rohde, P., Lewinsohn, P. M., Klein, D. N., & Seeley, J. R. (2005). Association of parental depression with psychiatric course from adolescence to young adulthood among formerly depressed individuals. Journal of Abnormal Psychology, 114, 409420.

Scott, J., & Colom, F. (2005). Psychosocial treatments for bipolar disorders. Psychiatric Clinics of North America, 28, 371384.

Seehusen, D. A., Baldwin, L. M., Runkle, G. P., & Clark, G. (2005). Are family physicians appropriately screening for postpartum depression? Journal of the American Board of Family Practice, 18, 104112.

Seligman, M. E., & Beagley, G. (1975). Learned helplessness in the rat. Journal of Comparative Physiology and Psychology, 88, 534541.

Simon, N. M., Otto, M. W., Wisniewski, S. R., Fossey, M., Sagduyu, K., Frank, E., et al. (2004). Anxiety disorder comorbidity in bipolar disorder patients: Data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). American Journal of Psychiatry, 161, 22222229.

Sonne, S. C., Brady, K. T., & Morton, W. A. (1994). Substance abuse and bipolar affective disorder. Journal of Nervous and Mental Disorders, 182, 349352.

Strakowski, S. M., DelBello, M. P., Fleck, D. E., & Arndt, S. (2000). The impact of substance abuse on the course of bipolar disorder. Biological Psychiatry, 48, 477485.

Strober, M., Morrell, W., Burroughs, J., Lampert, C., Danforth, H., & Freeman, R. (1988). A family study of bipolar I disorder in adolescence. Early onset of symptoms linked to increased familial loading and lithium resistance. Journal of Affective Disorders, 15, 255268.

Suppes, T., Leverich, G. S., Keck, P. E., Nolen, W. A., Denicoff, K. D., Altshuler, L. L., et al. (2001). The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. Journal of Affective Disorders, 67, 4559.

Temkin, N. R., Jarell, A. D., & Anderson, G. D. (2001). Antiepileptogenic agents: How close are we? Drugs, 61, 10451055.

Tsankova, N. M., Berton, O., Renthal, W., Kumar, A., Neve, R. L., & Nestler, E. J. (2006). Sustained hippocampal chromatin regulation in a mouse model of depression and antidepressant action. Nature Neuroscience, 9, 519525.

Vieta, E., & Colom, F. (2004). Psychological interventions in bipolar disorder: From wishful thinking to an evidence-based approach. Acta Psychiatrica Scandinavica, 110(Suppl. 422), 3438.

Vieta, E., Pacchiarotti, I., Scott, J., Sanchez-Moreno, J., Di Marzo, S., & Colom, F. (2005). Evidence-based research on the efficacy of psychologic interventions in bipolar disorders: A critical review. Current Psychiatry Report, 7, 449455.

Wang, P. S., Berglund, P., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 603613.

Weinzimer, S. A., Doyle, E. A., & Tamborlane, W. V., Jr. (2005). Disease management in the young diabetic patient: Glucose monitoring, coping skills, and treatment strategies. Clinical Pediatrics (Philadelphia), 44, 393403.

Yehuda, R., Halligan, S. L., & Bierer, L. M. (2001). Relationship of parental trauma exposure and PTSD to PTSD, depressive and anxiety disorders in offspring. Journal of Psychiatric Research, 35, 261270.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Development and Psychopathology
  • ISSN: 0954-5794
  • EISSN: 1469-2198
  • URL: /core/journals/development-and-psychopathology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 9
Total number of PDF views: 56 *
Loading metrics...

Abstract views

Total abstract views: 285 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 27th May 2017. This data will be updated every 24 hours.