Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Dec:169:144-8.
doi: 10.1016/j.jad.2014.08.019. Epub 2014 Aug 20.

The effect of personalized guideline-concordant treatment on quality of life and functional impairment in bipolar disorder

Louisa G Sylvia  1 , Dustin J Rabideau  2 , Andrew A Nierenberg  2 , Charles L Bowden  3 , Edward S Friedman  4 , Dan V Iosifescu  5 , Michael E Thase  6 , Terence Ketter  7 , Elizabeth A Greiter  2 , Joseph R Calabrese  8 , Andrew C Leon  9 , Michael J Ostacher  10 , Noreen Reilly-Harrington  2
Affiliations
Randomized Controlled Trial

The effect of personalized guideline-concordant treatment on quality of life and functional impairment in bipolar disorder

Louisa G Sylvia et al. J Affect Disord. 2014 Dec.

Abstract

Objectives: The aims of this study were to evaluate correlates and predictors of life functioning and quality of life in bipolar disorder during a comparative effectiveness trial of moderate doses of lithium.

Methods: In the Lithium treatment moderate-dose use study (LiTMUS), 283 symptomatic outpatients with bipolar disorder type I or II were randomized to receive lithium plus "optimal personalized treatment (OPT)", or OPT alone. Participants were assessed using structured diagnostic interviews, clinician-rated blinded assessments, and questionnaires. We employ linear mixed effects models to test the effect of treatment overall and adjunct lithium specifically on quality of life or functioning. Similar models are used to examine the association of baseline demographics and clinical features with quality of life and life functioning.

Results: Quality of life and impaired functioning at baseline were associated with lower income, higher depressive severity, and more psychiatric comorbid conditions. Over 6 months, patients in both treatment groups improved in quality of life and life functioning (p-Values<0.0001); without a statistically significant difference between the two treatment groups (p-Values>0.05). Within the lithium group, improvement in quality of life and functioning was not associated with concurrent lithium levels at week 12 or week 24 (p-Values>0.05). Lower baseline depressive severity and younger age of onset predicted less improvement in functioning over 6 months.

Conclusions: Optimized care for bipolar disorder improves overall quality of life and life functioning, with no additional benefit from adjunct moderate doses of lithium. Illness burden and psychosocial stressors were associated with worse quality of life and lower functioning in individuals with bipolar disorder.

Keywords: Bipolar disorder; Life functioning; Lithium; Quality of life.

PubMed Disclaimer

Conflict of interest statement

Mr. Rabideau reports no competing interests.

Dr. Ostacher reports no competing interests.

Dr. Leon served on independent Data and Safety Monitoring Boards for AstraZeneca, Sunovion, and Pfizer. He served as a consultant and advisor to FDA, NIMH, MedAvante, and Roche and had equity in MedAvante.

Ms. Greiter reports no competing interests.

Dr. Thase reports no conflicts of interest specifically pertaining to this project. During the past three years he has been an advisor/consultant: to Alkermes, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceuticals, Lundbeck, MedAvante, Merck, Mylan, Neuronetics, Otsuka, Pamlab, PharmaNeuroboost, Pfizer, Rexahn, Roche, Shire, Sunovion, Supernus, Takeda, and Teva, as well as the US Food and Drug Administration and the National Institute of Mental Health. During the same time frame, Dr. Thase has received honoraria for talks from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Merck, and Pfizer and he has received research grants from Alkermes, AstraZeneca, Eli Lilly, Forest, GlaxoSmithKline, Otsuka, PharmaNeuroboost, and Roche, as well as the National Institute of Mental Health and the Agency for Healthcare Research and Quality.

Dr. Bowden is a research collaborator with Elan and a consultant with Teva, He has no participation with speaker bureaus, nor does he or his wife hold any equity position in any biomedical or pharmaceutical corporation.

Similar articles

See all similar articles

Cited by

References

    1. Robb JC, Cooke R, Devins GM, et al. Quality of life and lifestyle disruption in euthymic bipolar disorder. J Psychiatr Res. 1997;31(5):509–517. - PubMed
    1. Sierra P, Livianos L, Rojo L. Quality of life for patients with bipolar disorder: relationship with clinical and demographic variables. Bipolar Disord. 2005;7(2):159–165. - PubMed
    1. Gitlin MJ, Swendsen J, Heller TL, Hammen C. Relapse and impairment in bipolar disorder. Am J Psychiatry. 1995;152(11):1635–1640. - PubMed
    1. Zarate CA, Tohen M, Land M, Cavanagh S. Functional impairment and cognition in bipolar disorder. Psychiatr Q. 2000;71(4):309–329. - PubMed
    1. Carlson GA, Kotov R, Chang S. Early determinants of four-year clinical outcomes in bipolar disorder with psychosis. Bipolar Disord. 2012;4(1):19–30. - PMC - PubMed

Publication types