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Treatment-resistant and Multi-therapy resistant criteria for bipolar depression: A consensus definition – CORRIGENDUM
- Diego Hidalgo-Mazzei, Michael Berk, Andrea Cipriani, Anthony J. Cleare, Arianna Di Florio, Daniel Dietch, John R. Geddes, Guy M. Goodwin, Heinz Grunze, Joseph F. Hayes, Ian Jones, Siegfried Kasper, Karine Macritchie, R. Hamish McAllister-Williams, Richard Morriss, Sam Nayrouz, Sofia Pappa, Jair C. Soares, Daniel J. Smith, Trisha Suppes, Peter Talbot, Eduard Vieta, Stuart Watson, Lakshmi N. Yatham, Allan H. Young, Paul R. A. Stokes
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- Journal:
- The British Journal of Psychiatry / Volume 214 / Issue 5 / May 2019
- Published online by Cambridge University Press:
- 28 February 2019, p. 309
- Print publication:
- May 2019
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Treatment-resistant and multi-therapy-resistant criteria for bipolar depression: consensus definition
- Diego Hidalgo-Mazzei, Michael Berk, Andrea Cipriani, Anthony J. Cleare, Arianna Di Florio, Daniel Dietch, John R. Geddes, Guy M. Goodwin, Heinz Grunze, Joseph F. Hayes, Ian Jones, Siegfried Kasper, Karine Macritchie, R. Hamish McAllister-Williams, Richard Morriss, Sam Nayrouz, Sofia Pappa, Jair C. Soares, Daniel J. Smith, Trisha Suppes, Peter Talbot, Eduard Vieta, Stuart Watson, Lakshmi N. Yatham, Allan H. Young, Paul R. A. Stokes
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- Journal:
- The British Journal of Psychiatry / Volume 214 / Issue 1 / January 2019
- Published online by Cambridge University Press:
- 06 December 2018, pp. 27-35
- Print publication:
- January 2019
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Background
Most people with bipolar disorder spend a significant percentage of their lifetime experiencing either subsyndromal depressive symptoms or major depressive episodes, which contribute greatly to the high levels of disability and mortality associated with the disorder. Despite the importance of bipolar depression, there are only a small number of recognised treatment options available. Consecutive treatment failures can quickly exhaust these options leading to treatment-resistant bipolar depression (TRBD). Remarkably few studies have evaluated TRBD and those available lack a comprehensive definition of multi-therapy-resistant bipolar depression (MTRBD).
AimsTo reach consensus regarding threshold definitions criteria for TRBD and MTRBD.
MethodBased on the evidence of standard treatments available in the latest bipolar disorder treatment guidelines, TRBD and MTRBD criteria were agreed by a representative panel of bipolar disorder experts using a modified Delphi method.
ResultsTRBD criteria in bipolar depression was defined as failure to reach sustained symptomatic remission for 8 consecutive weeks after two different treatment trials, at adequate therapeutic doses, with at least two recommended monotherapy treatments or at least one monotherapy treatment and another combination treatment. MTRBD included the same initial definition as TRBD, with the addition of failure of at least one trial with an antidepressant, a psychological treatment and a course of electroconvulsive therapy.
ConclusionsThe proposed TRBD and MTRBD criteria may provide an important signpost to help clinicians, researchers and stakeholders in judging how and when to consider new non-standard treatments. However, some challenging diagnostic and therapeutic issues were identified in the consensus process that need further evaluation and research.
Declaration of interestIn the past 3 years, M.B. has received grant/research support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, MBF, NHMRC, Beyond Blue, Rotary Health, Geelong Medical Research Foundation, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Meat and Livestock Board, Organon, Novartis, Mayne Pharma, Servier, Woolworths, Avant and the Harry Windsor Foundation, has been a speaker for Astra Zeneca, Bristol Myers Squibb, Eli Lilly, Glaxo SmithKline, Janssen Cilag, Lundbeck, Merck, Pfizer, Sanofi Synthelabo, Servier, Solvay and Wyeth and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Eli Lilly, Grunbiotics, Glaxo SmithKline, Janssen Cilag, LivaNova, Lundbeck, Merck, Mylan, Otsuka, Pfizer and Servier. A.J.C. has in the past 3 years received honoraria for speaking from Astra Zeneca and Lundbeck, honoraria for consulting from Allergan, Janssen, Lundbeck and LivaNova and research grant support from Lundbeck. G.M.G. holds shares in P1Vital and has served as consultant, advisor or CME speaker for Allergan, Angelini, Compass pathways, MSD, Lundbeck, Otsuka, Takeda, Medscape, Minervra, P1Vital, Pfizer, Servier, Shire and Sun Pharma. J.G. has received research funding from National Institute for Health Research, Medical Research Council, Stanley Medical Research Institute and Wellcome. H.G. received grants/research support, consulting fees or honoraria from Gedeon Richter, Genericon, Janssen Cilag, Lundbeck, Otsuka, Pfizer and Servier. R.H.M.-W. has received support for research, expenses to attend conferences and fees for lecturing and consultancy work (including attending advisory boards) from various pharmaceutical companies including Astra Zeneca, Cyberonics, Eli Lilly, Janssen, Liva Nova, Lundbeck, MyTomorrows, Otsuka, Pfizer, Roche, Servier, SPIMACO and Sunovion. R.M. has received research support from Big White Wall, Electromedical Products, Johnson and Johnson, Magstim and P1Vital. S.N. received honoraria from Lundbeck, Jensen and Otsuka. J.C.S. has received funds for research from Alkermes, Pfizer, Allergan, J&J, BMS and been a speaker or consultant for Astellas, Abbott, Sunovion, Sanofi. S.W has, within the past 3 years, attended advisory boards for Sunovion and LivaNova and has undertaken paid lectures for Lundbeck. D.J.S. has received honoraria from Lundbeck. T.S. has reported grants from Pathway Genomics, Stanley Medical Research Institute and Palo Alto Health Sciences; consulting fees from Sunovion Pharamaceuticals Inc.; honoraria from Medscape Education, Global Medical Education and CMEology; and royalties from Jones and Bartlett, UpToDate and Hogrefe Publishing. S.P. has served as a consultant or speaker for Janssen, and Sunovion. P.T. has received consultancy fees as an advisory board member from the following companies: Galen Limited, Sunovion Pharmaceuticals Europe Ltd, myTomorrows and LivaNova. E.V. received grants/ research support, consulting fees or honoraria from Abbott, AB-Biotics, Allergan, Angelini, Dainippon Sumitomo, Ferrer, Gedeon Richter, Janssen, Lundbeck, Otsuka and Sunovion. L.N.Y. has received grants/research support, consulting fees or honoraria from Allergan, Alkermes, Dainippon Sumitomo, Janssen, Lundbeck, Otsuka, Sanofi, Servier, Sunovion, Teva and Valeant. A.H.Y. has undertaken paid lectures and advisory boards for all major pharmaceutical companies with drugs used in affective and related disorders and LivaNova. He has also previously received funding for investigator-initiated studies from AstraZeneca, Eli Lilly, Lundbeck and Wyeth. P.R.A.S. has received research funding support from Corcept Therapeutics Inc. Corcept Therapeutics Inc fully funded attendance at their internal conference in California USA and all related expenses. He has received grant funding from the Medical Research Council UK for a collaborative study with Janssen Research and Development LLC. Janssen Research and Development LLC are providing non-financial contributions to support this study. P.R.A.S. has received a presentation fee from Indivior and an advisory board fee from LivaNova.
Contributors
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- By Pratap R. Chokka, Louisa K. Coulson, Vivienne A. Curtis, Anne Duffy, Klaus P. Ebmeier, I. Nicol Ferrier, E. Jane Garland, Jose M. Goikolea, Heinz Grunze, Carol Henshaw, Lucie L. Herrmann, Chennattucherry John Joseph, Annie J. Kuan, Adrian J. Lloyd, Karine A.N. Macritchie, Marisa Le Masurier, Victoria Maxwell, Erin E. Michalak, Yee Ming Mok, Richard Morriss, Greg Murray, Charles B. Nemeroff, Sagar V. Parikh, Giulio Perugi, Dina Popovic, Alan J. Thomas, Vytas Velyvis, Eduard Vieta, Lakshmi N. Yatham, Vikram K. Yeragani, Allan H. Young
- Edited by Allan H. Young, University of British Columbia, Vancouver, I. Nicol Ferrier, University of Newcastle upon Tyne, Erin E. Michalak, University of British Columbia, Vancouver
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- Book:
- Practical Management of Bipolar Disorder
- Published online:
- 04 August 2010
- Print publication:
- 20 May 2010, pp vi-viii
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White matter microstructural abnormalities in euthymic bipolar disorder
- Karine A. N. Macritchie, Adrian J. Lloyd, Mark E. Bastin, Kamini Vasudev, Peter Gallagher, Rachel Eyre, Ian Marshall, Joanna M. Wardlaw, I. Nicol Ferrier, P. Brian Moore, Allan H. Young
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- Journal:
- The British Journal of Psychiatry / Volume 196 / Issue 1 / January 2010
- Published online by Cambridge University Press:
- 02 January 2018, pp. 52-58
- Print publication:
- January 2010
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Background
Abnormal diffusion parameters are reported in specific brain regions and white matter tracts in bipolar disorder.
AimsTo investigate whether these abnormalities are generalised, and thus evident in large regions of white matter.
MethodDiffusion parameters were measured at several regions in the corpus callosum and in deep/periventricular white matter in 28 currently euthymic patients with bipolar disorder and controls. White matter hyperintensity loads were assessed.
ResultsComparing the whole data-sets using the sign test, in the group with bipolar disorder, mean diffusivity was greater at all 15 sites (P<0.001) and fractional anisotropy was reduced at 13 (P<0.01). The effect of diagnosis was significant for callosal mean diffusivity and fractional anisotropy and for deep/periventricular mean diffusivity (MANCOVA). Comparing individual regions (Mann–Whitney U-test), prefrontal and periventricular mean diffusivity were significantly increased; callosal and occipital fractional anisotropy were significantly reduced. Former substance use and lithium were possible confounding factors. Periventricular white matter hyperintensities were associated with significantly increased periventricular mean diffusivity in individuals with bipolar disorder.
ConclusionsGeneralised white matter microstructural abnormalities may exist in bipolar disorder, possibly exacerbated by past substance use and ameliorated by lithium.