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An overview of recent findings of the Stanley Foundation Bipolar Network (Part I)

Authors

  • Robert M Post,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • a Gabriele S Leverich,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • a Lori L Altshuler,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • b Mark A Frye,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • b Trisha M Suppes,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • c Paul E Keck Jr,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • d Susan L McElroy,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • d Ralph Kupka,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • e Willem A Nolen,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • e Heinz Grunze,

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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  • and f Jorg Walden g

    1. a  Stanley Foundation Bipolar Network and Biological Psychiatry Branch, NIMH, NIH, DHHS, Bethesda, MD, USA , b  UCLA Ambulatory Clinical Research Center and VA Medical Center, Los Angeles, CA, USA , c  University of Texas-Southwestern Medical Center, Dallas, TX, USA , d  University of Cincinnati College of Medicine, Cincinnati, OH, USA , e  Altrecht Institute for Mental Health, University Medical Center, Utrecht, The Netherlands , f  Psychiatrische Klinik der LMU, Munich, Germany , g  Zentrum fur innovative Therapie bipolarer Storungen am Universitatsklinikum, Freiburg, Germany
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Robert M Post, MD, Biological Psychiatry Branch, Bldg 10, Room 3S239, 10 Center Drive, MSC-1272, Bethesda, MD 20892-1272, USA.
Fax: 301 402 0052; e-mail: robert.post@nih.gov

Abstract

Aim and Methods: Selected recent findings of the Stanley Foundation Bipolar Network are briefly reviewed and their clinical implications discussed.

Results: Daily prospective ratings on the NIMH-LCM indicate a high degree of residual depressive morbidity (three times that of hypomania or mania) despite active psychopharmacological treatment with a variety of modalities including mood stabilizers, antidepressants, and benzodiazepines, as well as antipsychotics as necessary. The rates of switching into brief to full hypomania or mania during the use of antidepressants is described, and new data suggesting the potential utility of continuing antidepressants in the small group of patients showing an initial acute and persistent response is noted. Bipolar patients with a history of major environmental adversities in childhood have a more severe course of illness and an increased incidence of suicide attempts compared with those without. Preliminary open data suggest useful antidepressant effects of the atypical antipsychotic quetiapine, while a double-blind randomized controlled study failed to show efficacy of omega-3 fatty acids (6 g of eicosapentaenoic acid compared with placebo for 4 months) in the treatment of either acute depression or rapid cycling. The high prevalence of overweight and increased incidence of antithyroid antibodies in patients with bipolar illness is highlighted.

Conclusions: Together, these findings suggest a very high degree of comorbidity and treatment resistance in outpatients with bipolar illness treated in academic settings and the need to develop not only new treatment approaches, but also much earlier illness recognition, diagnosis, and intervention in an attempt to reverse or prevent this illness burden.

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