Clinical correlates associated with the long-term response of bipolar disorder patients to lithium, valproate or lamotrigine: A retrospective study

• Published in: PloS one Vol. 15; no. 1; p. e0227217
• Main Authors: Woo, Young Sup, Yoon, Bo-Hyun, Song, Jye-Heon, Seo, Jeong Seok, Nam, Beomwoo, Lee, Kwanghun, Lee, Jonghun, Jung, Young-Eun, Kim, Moon-Doo, Lee, Jung Goo, Wang, Sheng-Min, Kwon, Young-Joon, Bahk, Won-Myong
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 2020; Public Library of Science (PLoS)
• Subjects: Adult; Age; Alcoholism - epidemiology; Antimanic Agents - therapeutic use; Antipsychotic Agents - therapeutic use; Antipsychotics; Biology and Life Sciences; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - epidemiology; Comorbidity; Confidence intervals; Diagnosis; Family medical history; Female; Follow-Up Studies; Humans; Lamotrigine; Lamotrigine - therapeutic use; Lithium; Lithium Compounds - adverse effects; Lithium Compounds - therapeutic use; Male; Medical records; Medical schools; Medical services; Medicine; Medicine and Health Sciences; Middle Aged; Mood; Patients; Physical Sciences; Polarity; Psychiatrists; Psychiatry; Psychosis; Psychotropic drugs; Quality of life; Regression analysis; Retrospective Studies; Seoul - epidemiology; Statistical analysis; Studies; Substance use; Treatment Outcome; Valproic acid; Valproic Acid - therapeutic use; Variables; Variance analysis; Seoul; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0227217

Although mood stabilizers such as lithium (LIT), valproate (VAL), and lamotrigine (LMT) appear to be efficacious treatments for bipolar disorder (BD) in research settings, the long-term response to these mood stabilizers in clinical practice is highly variable among individuals. Thus, the present study examined the characteristics associated with good or insufficient responses to long-term treatment with LIT, VAL, or LMT for BD. This study retrospectively analyzed the medical records of patients who visited an outpatient clinic with a diagnosis of BD I or II. Data from patients who were treated with one of three mood stabilizing medications (LIT, VAL, or LMT) for more than 6 months were selected, and the long-term treatment responses were evaluated using the Alda scale. For the purposes of this study, two response categories were formed: insufficient response (ISR), including non-response or poor response (Alda total score ≤ 6), and good response (GR; Alda total score ≥ 7). Of the 645 patients included in the present study, 172 were prescribed LIT, 320 were prescribed VAL, and 153 were prescribed LMT for at least 6 months. A binary logistic regression analysis revealed that a diagnosis of BD II (odds ratio [OR], 8.868; 95% confidence interval [CI], 1.123-70.046; p = 0.038), comorbid alcohol/substance use disorder (OR, 4.238; 95% CI, 1.154-15.566; p = 0.030), and a history of mixed episodes (OR, 4.363; 95% CI, 1.191-15.985; p = 0.026) were significant predictors of LIT-ISR. Additionally, a depressive-predominant polarity significantly predicted LMT-GR (OR, 8.586; 95% CI, 2.767-26.644; p < 0.001). The present findings demonstrated that patients with a diagnosis of BD II, a comorbid alcohol/substance problem, or a history of mixed episodes were not likely to respond to LIT treatment. Additionally, LMT might be a better treatment choice for patients with a depressive-predominant polarity.