Limits...
Who will benefit from antidepressants in the acute treatment of bipolar depression? A reanalysis of the STEP-BD study by Sachs et al. 2007, using Q-learning.

Wu F, Laber EB, Lipkovich IA, Severus E - Int J Bipolar Disord (2015)

Bottom Line: There is substantial uncertainty regarding the efficacy of antidepressants in the treatment of bipolar disorders.Using data from the acute depression randomized care (RAD) pathway of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, we estimate an optimal dynamic treatment regime via Q-learning.The estimated optimal treatment regime presents some evidence that patients in the RAD pathway of STEP-BD who experienced a (hypo)manic episode before the depressive episode may do better to forgo adding an antidepressant to a mandatory mood stabilizer.

View Article: PubMed Central - PubMed

Affiliation: Department of Statistics, North Carolina State University, 2311 Stinson Drive, Raleigh, 27695 USA.

ABSTRACT

Background: There is substantial uncertainty regarding the efficacy of antidepressants in the treatment of bipolar disorders.

Methods: Traditional randomized controlled trials and statistical methods are not designed to discover if, when, and to whom an intervention should be applied; thus, other methodological approaches are needed that allow for the practice of personalized, evidence-based medicine with patients with bipolar depression.

Results: Dynamic treatment regimes operationalize clinical decision-making as a sequence of decision rules, one per stage of clinical intervention, that map patient information to a recommended treatment. Using data from the acute depression randomized care (RAD) pathway of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, we estimate an optimal dynamic treatment regime via Q-learning.

Conclusions: The estimated optimal treatment regime presents some evidence that patients in the RAD pathway of STEP-BD who experienced a (hypo)manic episode before the depressive episode may do better to forgo adding an antidepressant to a mandatory mood stabilizer.

No MeSH data available.


Related in: MedlinePlus

Variable missingness. Variables with missing data are listed. The SUMMi and SUMDi denote continuous symptom subscales for depression and mood elevation at ith stage. The Trti denotes current treatment at stage i. The responsei denotes patients’ clinical status at the end of stage i. The SIDEj represents different side effects. PRONSET denotes patients’ prior to onset clinical status. EDUCATE, EMPLOY, MARSTAT, MEDINS, and HINCOME are the indicators for patients’ education level, employment status, marriage status, medical insurance, and annual home income, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4383759&req=5

Fig3: Variable missingness. Variables with missing data are listed. The SUMMi and SUMDi denote continuous symptom subscales for depression and mood elevation at ith stage. The Trti denotes current treatment at stage i. The responsei denotes patients’ clinical status at the end of stage i. The SIDEj represents different side effects. PRONSET denotes patients’ prior to onset clinical status. EDUCATE, EMPLOY, MARSTAT, MEDINS, and HINCOME are the indicators for patients’ education level, employment status, marriage status, medical insurance, and annual home income, respectively.

Mentions: Figure 3 shows the proportions of missing values for the variables under consideration in our analysis of the RAD data. There is a significant amount of missing covariate information at both stages; thus, discarding subjects with missing information is inefficient and may introduce bias (Little and Rubin 2002).Figure 3


Who will benefit from antidepressants in the acute treatment of bipolar depression? A reanalysis of the STEP-BD study by Sachs et al. 2007, using Q-learning.

Wu F, Laber EB, Lipkovich IA, Severus E - Int J Bipolar Disord (2015)

Variable missingness. Variables with missing data are listed. The SUMMi and SUMDi denote continuous symptom subscales for depression and mood elevation at ith stage. The Trti denotes current treatment at stage i. The responsei denotes patients’ clinical status at the end of stage i. The SIDEj represents different side effects. PRONSET denotes patients’ prior to onset clinical status. EDUCATE, EMPLOY, MARSTAT, MEDINS, and HINCOME are the indicators for patients’ education level, employment status, marriage status, medical insurance, and annual home income, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4383759&req=5

Fig3: Variable missingness. Variables with missing data are listed. The SUMMi and SUMDi denote continuous symptom subscales for depression and mood elevation at ith stage. The Trti denotes current treatment at stage i. The responsei denotes patients’ clinical status at the end of stage i. The SIDEj represents different side effects. PRONSET denotes patients’ prior to onset clinical status. EDUCATE, EMPLOY, MARSTAT, MEDINS, and HINCOME are the indicators for patients’ education level, employment status, marriage status, medical insurance, and annual home income, respectively.
Mentions: Figure 3 shows the proportions of missing values for the variables under consideration in our analysis of the RAD data. There is a significant amount of missing covariate information at both stages; thus, discarding subjects with missing information is inefficient and may introduce bias (Little and Rubin 2002).Figure 3

Bottom Line: There is substantial uncertainty regarding the efficacy of antidepressants in the treatment of bipolar disorders.Using data from the acute depression randomized care (RAD) pathway of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, we estimate an optimal dynamic treatment regime via Q-learning.The estimated optimal treatment regime presents some evidence that patients in the RAD pathway of STEP-BD who experienced a (hypo)manic episode before the depressive episode may do better to forgo adding an antidepressant to a mandatory mood stabilizer.

View Article: PubMed Central - PubMed

Affiliation: Department of Statistics, North Carolina State University, 2311 Stinson Drive, Raleigh, 27695 USA.

ABSTRACT

Background: There is substantial uncertainty regarding the efficacy of antidepressants in the treatment of bipolar disorders.

Methods: Traditional randomized controlled trials and statistical methods are not designed to discover if, when, and to whom an intervention should be applied; thus, other methodological approaches are needed that allow for the practice of personalized, evidence-based medicine with patients with bipolar depression.

Results: Dynamic treatment regimes operationalize clinical decision-making as a sequence of decision rules, one per stage of clinical intervention, that map patient information to a recommended treatment. Using data from the acute depression randomized care (RAD) pathway of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, we estimate an optimal dynamic treatment regime via Q-learning.

Conclusions: The estimated optimal treatment regime presents some evidence that patients in the RAD pathway of STEP-BD who experienced a (hypo)manic episode before the depressive episode may do better to forgo adding an antidepressant to a mandatory mood stabilizer.

No MeSH data available.


Related in: MedlinePlus