Response and remission rates during 24 weeks of mood-stabilizing treatment for bipolar depression depending on early non-response

Ole Köhler-Forsberg, Kirstine H. Sloth, Louisa G. Sylvia, Michael Thase, Joseph R. Calabrese, Mauricio Tohen, Charles L. Bowden, Melvin McInnis, James H. Kocsis, Edward S. Friedman, Terence A. Ketter, Susan L. McElroy, Richard C. Shelton, Dan V. Iosifescu, Michael J. Ostacher, Andrew A. Nierenberg

Research output: Contribution to journalArticlepeer-review


Background: We aimed to study the probability of bipolar depression response at 24 weeks given initial non-response. Methods: We combined two multi-site, 24-week trials including similar populations following the same evidence-based guidelines randomizing patients to lithium or quetiapine. Additional mood-stabilizing treatment was possible if clinically indicated. We report cumulative proportions of response (>50% improvement in MADRS) and remission (MADRS<10). Results: We included 592 participants with bipolar depression (mean 39 years, 59% female, mean MADRS 25). Among 393 (66%) participants without response after 2 weeks, 46% responded by 24 weeks; for 291 (49%) without response at 4 weeks, 40% responded and 33% remitted by 24 weeks; for 222 (38%) without a response at 6 weeks, 36% responded and 29% remitted by 24 weeks; for 185 (31%) without a response at 8 weeks, 29% responded and 24% remitted by 24 weeks. Rates were similar for participants who had started an additional mood-stabilizing drug during the first 6 or 8 weeks. Conclusions: Among patients with bipolar depression and non-response after 6 weeks treatment, representing an adequate bipolar depression trial, only one-third responded by 24 weeks. These results highlight the need for better treatment alternatives for non-responders to evidence-based treatments for bipolar depression.

Original languageEnglish
Article number114194
JournalPsychiatry Research
StatePublished - Nov 2021
Externally publishedYes


  • Antidepressant treatment
  • Bipolar depression
  • Early non-response
  • Lithium
  • Mood-stabilizing
  • Quetiapine
  • Response


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