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A factor analytic study in bipolar depression, and response to lamotrigine

Published online by Cambridge University Press:  23 May 2013

Philip B. Mitchell ,
Dusan Hadzi-Pavlovic ,
Gary Evoniuk ,
Joseph R. Calabrese  and
Charles L. Bowden
Philip B. Mitchell*
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
Dusan Hadzi-Pavlovic
Affiliation:
School of Psychiatry, University of New South Wales, Sydney, Australia Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
Gary Evoniuk
Affiliation:
GlaxoSmithKline Research and Development, Research Triangle Park, North Carolina, USA
Joseph R. Calabrese
Affiliation:
Mood Disorders Program, UH Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Charles L. Bowden
Affiliation:
Department of Psychiatry, The University of Texas Health Science Centre, San Antonio, Texas, USA
*
*Address for correspondence: Scientia Professor Philip Mitchell, Head, School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Randwick, NSW 2031, Australia. (Email phil.mitchell@unsw.edu.au)
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Abstract

Objective

There have been no previous factor analytic studies of the Hamilton Depression Rating Scale (HDRS) in samples with bipolar I depression, and no investigations of the utility of any derived factors in determining treatment response in this condition. This study aimed to identify and compare factors of a 31-item version of the HDRS (HDRS-31) in large samples of patients with bipolar depression and Major Depressive Disorder (MDD), then examine the responsiveness of such factors to lamotrigine compared with placebo in the bipolar depressed sample.

Methods

This multivariate analytical study was performed on 2 large depressed samples (one bipolar and the other MDD) that had been recruited for separate, contemporaneous, double-blind placebo-controlled trials of lamotrigine. The 2 studies had similar designs and assessment tools, the major measures being the Montgomery–Asberg Depression Rating Scale (MADRS) and HDRS-31. To identify the constructs underlying the scale, exploratory factor analyses were conducted using HDRS-31 baseline scores. Treatment responsiveness in the bipolar depressed sample—as indicated by improvement in the total MADRS and HDRS-31, as well as HDRS factors—were examined using both a mixed-effects analysis and individual time-point t-tests.

Results

Seven factors of the HDRS-31 were identified: I—“depressive cognitions,” II—“psychomotor retardation,” III—“insomnia,” IV—“hypersomnia,” V—“appetite and weight change,” VI—“anxiety,” and VII—“anergia.” A significant therapeutic effect of lamotrigine in bipolar depression was found for the “depressive cognitions” factor (from week 3) and “psychomotor retardation” (from week 4).

Conclusion

This study has identified 7 factors of the HDRS in a large sample of patients with bipolar depression. The results suggest that that the clinical benefits of lamotrigine in acute bipolar depression are primarily upon depressive cognitions and psychomotor slowing.

Keywords

Bipolar depressionfactor analysislamotriginemajor depressive disordermultivariate statistics
Type
Original Research
Information
CNS Spectrums , Volume 18 , Issue 4 , August 2013 , pp. 214 - 224
Copyright
Copyright © Cambridge University Press 2013 

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Footnotes

The research activities of Philip Mitchell and Dusan Hadzi-Pavlovic are supported by the Australian National Health and Medical Research Council through Program Grant number 510135.

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