Depression symptom ratings in geriatric patients with bipolar mania

Abstract

Objective: Given the paucity of information available regarding standardized ratings of depression symptoms in bipolar manic states, and in particular those in older adults, we explored depression ratings in symptomatic participants in a multicenter study of treatment of bipolar I disorder in late life.

Methods: Baseline data was obtained from the first 100 patients enrolled in an NIMH-funded, 9-week, randomized, double-blind RCT comparing treatment with lithium or valproate in patients of age 60 years and older with Type I Bipolar mania or hypomania. This multi-site study was conducted at six academic medical centers in the United States and enrolled inpatients and outpatients with a total Young Mania Rating Scale (YMRS) score of 18 or greater. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS). The criterion for at least moderate bipolar depressive symptoms was the European College of Neuropsychopharmacology (ECNP) Consensus Meeting definition of HAM-D 17 total score >20.

Results: Eleven percent of patients had mixed symptoms defined by depression scale severity according to ECNP criterion. In the overall sample, total scores on the two depression scales were highly correlated. Total YMRS scores of this mixed symptom group were similar to the remainder of the sample.

Conclusions: These preliminary findings suggest that moderate to severe depressive symptoms occur in about one in ten bipolar manic elders. Future studies are needed to further evaluate symptom profiles, clinical correlates, and treatments for bipolar older adults with combined manic and depressive symptoms.

Conflict of interest statement

Conflict of Interests:

Martha Sajatovic, MD: Grant support: GlaxoSmithKline, AstraZeneca, Ortho-McNeil-Janssen Pharmaceuticals, Inc, Pfizer

Consultant: Cognition Group, United Biosource, ePharma Solutions, Janssen-Cilag

Rayan AlJurdi, MD: Grant/Research/financial support: Cyberonics, Stanley Foundation, National Institute of Mental Health, Suicide Prevention Internationals, Mental Illness Research, Education and Clinical Center, Cephalon, American Foundation for Suicide Prevention, NARSAD, GlaxoSmithKline, Evotec, and Roche, The Cognition Group

Ariel Gildengers, MD: has participated in scientific advisory board meetings for Shire Pharmaceuticals (completed 2007). He is a “minor” stock holder of Eli Lilly & Company (completed 2/11/2009).

Rebecca Greenberg, MS: No financial disclosures.

Thomas Tenhave, PhD: Investments with Johnson and Johnson, TIAA-CREF, and Calvert.

Martha Bruce, PhD, MPH: Research funding from NIMH; Consultant Funds from Medispin, Inc.

Benoit H. Mulsant, MD: Directly purchased stocks with General Electric; Grant and research support from the US National Institute of Health (current), the Canadian Institutes for Health Research (current), Brsitol-Myers Squibb (current), Wyeth (current).

Robert C. Young, MD: Research support from Glaxo SmithKline and AstraZeneca. Janssen has provided risperdone to some sites for research.

Copyright © 2011 John Wiley & Sons, Ltd.

Figures

Figure 1

HAM-D-17 and MADRS Total Scores in Bipolar Manic Elders (N=100)