RJB is a consultant to, or has collaborated in research with Alkermes, Auritec, Biotrofix, IFI, Janssen, JDS, Eli Lilly & Co., Merck, NeuroHealing, Novartis and Solvay Corporations. LT has conducted research supported by Eli Lilly & Co. and Janssen Corporations. CJB is an editor at the Deutsche Ärzteblatt, Cologne, Germany. BL and IMB have no disclosures of potential conflicts of interest.
Effects of treatment latency on response to maintenance treatment in manic-depressive disorders
Article first published online: 1 JUN 2007
Volume 9, Issue 4, pages 386–393, June 2007
How to Cite
Baldessarini, R. J., Tondo, L., Baethge, C. J., Lepri, B. and Bratti, I. M. (2007), Effects of treatment latency on response to maintenance treatment in manic-depressive disorders. Bipolar Disorders, 9: 386–393. doi: 10.1111/j.1399-5618.2007.00385.x
- Issue published online: 1 JUN 2007
- Article first published online: 1 JUN 2007
- Received 30 September 2005, revised and accepted for publication 2 June 2006
- bipolar disorder;
- episode counts;
- manic-depressive illness;
- treatment latency;
- treatment response
Objectives: To further test the hypothesis that past illness episodes and delay of long-term treatment do not limit maintenance treatment response among patients with manic-depressive illnesses (MDI).
Methods: In a sample of 764 MDI patients in Cagliari and Berlin, 77% of whom had bipolar disorder (BPD), we: (i) correlated treatment latency or pretreatment episode counts versus hospitalized morbidity during treatment; (ii) correlated treatment duration versus pretreatment morbidity; (iii) correlated treatment latency versus pretreatment or treated morbidity; (iv) modeled factors associated with longer treatment latency; (v) compared treatment latencies at extremes of treatment outcomes, and (vi) compared pretreatment morbidity within 2 years of the longest versus shortest treatment latency quartiles.
Results: Pretreatment morbidity was strongly correlated with shorter treatment latency, but morbidity during treatment was unrelated to treatment latency, pretreatment episode counts, sex, diagnosis, treatment type or treatment duration. In multivariate modeling, treatment latency was longer among patients who had experienced an early onset of illness, mainly in depressive disorders (BPD II and major depression) and among women, but was unrelated to morbidity during treatment. Patients with no illness recurrences during treatment and those who were ill at least 50% of the time had similar treatment latencies. Pretreatment morbidity occurring just prior to the initiation of long-term treatment was very similar at the highest and lowest treatment latencies.
Conclusions: These findings support the therapeutically favorable conclusion that prior episode counts and treatment delay have little association with morbidity during prophylaxis with mood-stabilizing agents. Comparisons of morbidity during versus before treatment in episodic disorders are misleading because overall morbidity becomes diluted with longer time-at-risk, whereas therapeutic intervention is typically determined by immediately preceding illness.