Outcome Measures to Consider Among Patients With Bipolar Disorder

Leslie Citrome, MD, clinical professor of psychiatry & behavioral sciences, New York Medical College, Valhalla, and founding director, Clinical Research and Evaluation Facility, Nathan S Kline Institute for Psychiatric Research, discusses why work productivity and quality of life are important considerations when treating patients with bipolar disorder.

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Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this episode, Dr Leslie Citrome emphasizes improving quality of life and work productivity in addition to symptoms in patients with bipolar depression.

I'm Dr Leslie Citrome. I'm a clinical professor of psychiatry and behavioral sciences at New York Medical College in Valhalla, New York. I have a private practice of psychiatry in Pomona, New York, and I serve as a voluntary consultant to the Assertive Community Treatment of the Mental Health Association of Rockland County.

I teach residents and work in the development of new medicines for major mental disorders including schizophrenia, bipolar disorder, and major depressive disorder.

Why is improvement in quality of life an important outcome and what does that mean for your patients?

I think we have to go back to the primary outcome of studies that are ordinarily done with medicines for bipolar depression, and that's usually to measure the decrease in symptoms over the course of several weeks compared to placebo. But the reduction of symptoms alone doesn't tell us the whole story of a person's trajectory towards wellness.

Although we can decrease symptoms, and that's a primary goal, we also want to improve other things in that person's life, including their level of functioning and how they perceive how they're doing.

Can you discuss the significance of reducing work absence and improving work productivity?

In addition to the quality of life, we have to look at other measures, such as someone's productivity at work. We've all known about absenteeism; that is, not getting to work. And that's very common in people who are ill, particularly with depression.

This is a real issue, when someone is acutely depressed, and they need to be able to get back to work. But what if they go back to work and they're not functioning at par at work? They're there but they're not really doing as much as they should be doing, and their coworkers are covering for them. That's called presenteeism.

This is a real problem for them, and it may lead to them eventually being fired for not carrying their own weight. So it's not just a matter of getting someone back to work, but back to work as functional as they were before.

And what are the benefits of having a wide dosing range when treating bipolar disorder?

Looking at all these outcomes that we discussed—decreasing symptoms, improving quality of life, improving being functional at work—it all involves a careful consideration of the treatment, and being able to modify the treatment so you can optimize treatment response and minimize tolerability problems, should they occur.

Having a wide dosing range allows us to titrate a medicine as high as necessary and to lower it if there are some issues with tolerability. With any medicine, there could be a dose response relationship with side effects. So we have to be able to reduce the dose readily in order to address that.

On the other hand, there may be a dose response relationship with that individual person, in terms of effectiveness or efficacy in reducing symptoms. We have to be able to adjust that too. That balance can be very helpful.

There's also the potential for other interactions with other diseases and other drugs that make it necessary for us to adjust the dose of the treatment for the depression.

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This transcript has been edited for clarity.