Clinical characteristics and long-term response to mood stabilizers in patients with bipolar disorder and different age at onset

Abstract

Bernardo Dell’Osso1, Massimiliano Buoli1, Riccardo Riundi2, Nazario D’Urso1, Sara Pozzoli1, Roberta Bassetti2, Emanuela Mundo1,  A Carlo Altamura11Department of Psychiatry, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano, Italy; 2Department of Clinical Sciences, Luigi Sacco, Milano, ItalyIntroduction: Bipolar disorder (BD) is a prevalent, comorbid, and impairing condition. Potential predictors of response to pharmacological treatment are object of continuous investigation in patients with BD. The present naturalistic study was aimed to assess clinical features and longterm response to mood stabilizers in a sample of bipolar subjects with different ages at onset. Methods: The study sample included 108 euthymic patients, diagnosed as affected by BD, either type I or II, according to the DSM-IV-TR, who were started on mood stabilizer treatment. Patients were followed-up for 24 months and the occurrence of any mood episode collected. At the end of the follow-up, patients were divided in three subgroups according to the age at onset (early-onset ≤30 years, middle-onset >30–≤45 years, and late-onset >45 years, respectively) and the long-term response to mood stabilizers was compared between them along with other clinical features.Results: The three subgroups showed significant differences in terms of clinical and demographic features and, with respect to long-term response to mood stabilizers, the early-onset subgroup showed a better outcome in terms of reduction of major depressive episodes during the 24-month follow-up compared to the other subgroups (one way ANOVA, F = 3.57, p = 0.032). Conclusions: Even though further controlled studies are needed to clarify the relationship between age at onset and outcome in BD, the present follow-up study suggests clinical peculiarities and different patterns of response to mood stabilizers across distinct subgroups of patients with BD and different ages at onset.Keywords: bipolar disorder, age at onset (AAO), mood stabilizers, long-term treatment