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01-05-2008 | Review Article

Burden of Bipolar Depression

Impact of Disorder and Medications on Quality of Life

Authors: Dr Erin E. Michalak, Greg Murray, Allan H. Young, Raymond W. Lam

Published in: CNS Drugs | Issue 5/2008

Abstract

Bipolar disorder is a complex, chronic psychiatric condition characterized by recurring episodes of depressive illness and mania or hypomania. Although the manic or hypomanic episodes define the disorder, recent research has shown that depressive symptoms predominate over manic symptoms in the majority of patients, and that bipolar depression accounts for much of the significant morbidity and mortality associated with bipolar disorder. Given these findings, there has been a recent upsurge of interest in furthering our understanding of the burden of depression in bipolar disorder. At the same time, increasing scientific attention is now being paid to expanding the measurement of outcome in bipolar disorder to encompass broader indicators of response, one of which is the assessment of quality of life (QOL).

In this review, we provide a summary of the current knowledge about QOL in the depressive phase of bipolar disorder, and the effects of pharmacological treatment interventions for bipolar disorder upon QOL. It appears that QOL is poorer in bipolar disorder than in other mood disorders and anxiety disorders, but that schizophrenia might compromise QOL more severely than bipolar disorder. Existing data also suggest that, for patients with bipolar disorder, QOL is negatively associated with depression, both as a cross-sectional mood state and perhaps also as a feature of the patient’s course. Despite its clinical and public health importance, bipolar depression has only recently started to receive the attention it warrants in clinical trials, and many important questions about its optimal pharmacological management remain to be answered. There is also a paucity of information about the impact of pharmacological interventions on QOL in bipolar depression. To our knowledge, only two clinical trials to date have specifically examined the impact of medications on QOL in patients with bipolar depression. A small number of other studies have examined the effects of depressive symptoms on QOL in patients who are experiencing manic or mixed episodes. Nonetheless, QOL appears to be a meaningful and important indicator of outcome and recovery in this patient population, and one that warrants further scientific interest and energy.

Although the terms functioning and QOL are often used interchangeably in the literature, many researchers agree that functional status and QOL are not identical constructs.[39]

To permit comparison across a limited number of studies, the terms QOL and HR-QOL are used interchangeably in this review.

The SF-36 is, to date, the most widely used HR-QOL measure in bipolar disorder research. It contains eight subscales assessing physical functioning, social functioning, role limitations (physical), role limitations (emotional), pain, mental health, general health and vitality, and yields an overall domain score on a 0—100 scale, where 0 represents worst possible health and 100 best possible health.

Full discussion of the concept of ‘health utilities’ in bipolar disorder is not within the scope of the current article, but the reader is pointed to Michalak et al.[21] for further review of this area.

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Title: Burden of Bipolar Depression
Impact of Disorder and Medications on Quality of Life
Authors: Dr Erin E. Michalak
Greg Murray
Allan H. Young
Raymond W. Lam
Publication date: 01-05-2008
Publisher: Springer International Publishing
Published in: CNS Drugs / Issue 5/2008
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI: https://doi.org/10.2165/00023210-200822050-00003

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Burden of Bipolar Depression

Impact of Disorder and Medications on Quality of Life

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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