STEP-BD Research Study

Question 1

STEP-BD

Answer 1

Systematic Treatment Enhancement Program for Bipolar Disorder

Question 2

Overview of STEP-BD study

Answer 2

. 4360 adult outpatients (1998-2005)
. Antipsychotics, Anti-epiletpitcs, and anti-depressants were used
. Types of psychotherapy used: family focused, interpersonal rhythm (sleep) therapy, CBT
. versus the control group which was “brief, collaborative professional contact.”

Question 3

STEP-BD early take homes

Answer 3

. After two years: 58.4% achieved recovery; 48.% had a recurrence (72% were depressive episode)
. Recurrence occurred in those who had residual symptoms (not full remission).
. There was no benefit found in adding an antidepressant to a mood stabilizer.
. There were no differences found between lamotrigine, risperidone, or inositol.

Question 4

STEP-BD take-homes for women

Answer 4

. Valproic acid (10.5% of the women were on Valproic acid and 1.4% were on another agent).
.increased the risk of polycystic ovary syndrome (PCOS).
. .increased menstrual irregulairiites
. acne
. a male pattern hair loss process
. elevated testosterone
. excessive body hair

Question 5

STEP-BD Take homes (five); Peters and colleagues (2011)- reanalysis of the data set

Answer 5

1. antidepressants and mood stabilizers were no more effective than placebo
2. antidepressants did not induce mania more frequently in placebo in the bipolar depressed individuals with NO history of antidepressant induced mania. (They found that SSRI and SNRIs do NOT induce mania in the bipolar depressed).
3. those with acute depressive episode with subsyndromal mania symptoms did not benefit from an antidepressant add-on to a mood stabilizer. They were actually more likely to relapse into depression or to become manic.
4. Lamotrigine is beneficial for treatment resistant bipolar depression.
5. Intensive psychosocial treatments provided more rapid recovery, improved social functioning, and greater life satisfaction than collaborative care.

Question 6

STEP-BD Take-homes (El-Mallakh, et al., 2015). They did a reanalysis of the Step data set

Answer 6

1. Antidepressants with antiepileptics drugs increased the rate of rapid cycling for rapid cyclers
2. Antiepileptics DO NOT PROTECT against depressive episdoes.
3. Bupropion is the ONLY antidepressant that does not induce rapid cycling.
4. Supports concern with antidepressants even when antiepileptic drugs are onboard.

Question 7

STEP-BD Take-Homes (Tada & colleagues, 2015)- reanalysis of the STEP data set.

Answer 7

. High dose antidepressants may be effective with patients with no mood destabilization, mania, or adverse events early in treatment.

Question 8

STEP-BD Take Homes (Mizushima et al., 2017)- reanalysis of the STEP data set.

Answer 8

1. If the individual reported an improvement in rating scale scores for self-esteem and loss of energy in the two weeks following the start of treatment then they experiences a more sustained recovery period.
2. If the individual was more active (i.e., improvement in scores measuring psychomotor activity), they would tend to go in the manic direction.