Evaluating response to mood stabilizers in patients with mixed depression: A study of agreement between three different mania rating scales and a depression rating scale

• Published in: Journal of affective disorders Vol. 197; pp. 1 - 7
• Main Authors: Shansis, Flávio Milman, Reche, Mateus, Capp, Edison
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2016
• Subjects: Adult; Agreement study; Antimanic Agents - therapeutic use; Bipolar disorder; Bipolar Disorder - diagnosis; Bipolar Disorder - etiology; Carbamazepine - therapeutic use; Depression rating scale; Depressive Disorder - complications; Depressive Disorder - drug therapy; Depressive Disorder - psychology; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Lithium Carbonate - therapeutic use; Male; Mania rating scales; Mixed symptoms; Mood stabilizers; Psychiatric Status Rating Scales; Psychiatry; Treatment Outcome; Valproic Acid - therapeutic use; Mood stabilizers; Agreement study; Bipolar disorder; Mixed symptoms; Depression rating scale; Mania rating scales
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2016.02.064

The aim of the present study was to evaluate agreement between three pairs formed by one of three mania scales (Young Mania Rating Scale [YMRS], Bech-Rafaelsen Mania Scale [BRMS], or the Clinician-Administered Rating Scale for Mania [CARS-M]) and a single depression scale (21-item Hamilton Depression Rating Scale [21-HAM-D]) for evaluation of response to mood stabilizers in patients with mixed bipolar disorder. Between 2010 and 2014, 68 consecutive bipolar type I and II outpatients with mixed depression as per DSM-IV-TR and Cincinnati criteria were included in this 8-week open-label trial to randomly receive carbamazepine, lithium carbonate, or valproic acid as monotherapy. Patterns of response (defined as a reduction of at least 50% in one of the mania scales and on the 21-HAM-D) were strikingly similar: 21-HAM-D+YMRS=22.1%, 21-HAM-D+BRMS=20.6%, and 21-HAM-D+CARS-M=23.5% (p<0.368). Assessment of agreement revealed very high kappa coefficients: 21-HAM-D+YMRS vs. 21-HAM-D+CARS-M, kappa=0.87; 21-HAM-D+YMRS vs. 21-HAM-D+BRMS, kappa=0.78; 21-HAM-D+CARS-M vs. 21-HAM-D+BRMS, kappa=0.91 (p<0.001). The decision to combine a depression rating scale with any one mania rating scale to assess treatment response in patients with mixed depression is questionable. The present study suggests that any one of the three tested mania rating scales (YMRS, BRMS, and CARS-M) can be combined with the 21-HAM-D to assess treatment response in patients with mixed bipolar disorder. This should give clinicians an added measure of confidence in using this strategy until valid, and specific instruments are developed for assessment of mixed states. •Of the 259 patients with Mood Disorders, 68 (26.2%) had mixed symptoms.•The response was approximately 20%, regardless of the combination of scales used.•Combinations of 21-HAM-D with YMRS, BRMS, and CARS-M had high agreement.