How Far We Haven't Come

To offer some background on the 90 percent lifetime recurrence of symptoms in bipolar disorder, here's the orginal abstract from the journal article "Course of illness and maintenance treatments for patients with bipolar disorder." It was published in the Journal of Clinical Psychiatry in Jan. 1995. The paper was cited in the most recent STEP-BD article I posted about yesterday and a reader basically asked "Where the fuck did that number come from?" Great question.

What's interesting to me is that the paper (I have to pay to get even a lousy html copy) would've been submitted to the editorial board of CJP in 1994, so this paper would have been looking at data from other studies circa late-80s to early-90s, so it's no surprise that the authors focused on Lithium and anti-convulsants. That's because atypicals essentially didn't exist in clinical settings for bipolars at that point, and anti-depressants were just starting to be researched in bipolars.

The 90 percent lifetime figure is not mentioned in the abstract itself. But look at what is: within one year of an episode, 50 percent of bipolars had another episode. So the same thing I've been bitching about on this blog--altogether now, "psych meds work 50 percent of the time"--is what the authors were pointing to before the advent of all the schmancy, side-effecty, costly, new jack psych meds. We haven't made a hell of a lot of progress, have we?

Here's the abstract pinched from PubMed:

BACKGROUND: Both naturalistic studies and treatment research on bipolar disorder are reviewed to describe its clinical course, the need for maintenance therapy, the efficacy of current pharmacologic prophylaxis, and the empirical basis for more comprehensive approaches to treatment.

METHOD: Articles were identified through computerized literature searches and from bibliographies of published studies, review articles, and textbooks.

RESULTS: Bipolar disorder is marked by multiple relapses and recurrences, as well as significant interepisode psychopathology. Within 1 year of recovery from a mood episode, half of all patients will have suffered a second episode. Various clinical and demographic variables have been investigated as risk factors for recurrence. Although lithium represents the single greatest advance in the treatment of this disease, it is clear that a substantial number of patients fail lithium prophylaxis, including those with a high frequency of prior episodes, mixed (dysphoric) mania, comorbid personality disturbance, and rapid cycling. The foremost pharmacologic alternatives to lithium are the anticonvulsants carbamazepine and valproate. Increased recognition of the psychosocial sequelae of bipolar disorder and the limitations of pharmacotherapy alone have led to the investigation of psychosocial interventions. These preliminary studies are small in number and of poor quality for the most part, but have nevertheless yielded positive findings.

CONCLUSION: Although lithium often fails to meet the clearly established need for prophylactic treatment, there is little evidence from rigorous clinical trials to support the wide-spread use of anticonvulsants in maintenance therapy. Treatment research should further examine these medications and the use of psychosocial treatments as adjuvants to pharmacotherapy.