Informing Intervention Strategies for Bipolar Disorder Using Dynamic Treatment Regimes

• Activity Number: 351
• Type: Contributed
• Date/Time: Tuesday, August 5, 2014 : 10:30 AM to 12:20 PM
• Sponsor: Mental Health Statistics Section
• Author(s): Fan Wu*+ and Eric B. Laber and Ilya Lipkovich and Emanuel Severus
• Companies: North Carolina State University and North Carolina State University and Quintiles and University Hospital Carl Gustav Carus Dresden
• Keywords: Bipolar Disorder ; Dynamic Treatment Regimes ; SMART design ; Q-learning

Abstract

There is substantial uncertainty regarding the efficacy of

antidepressants in the acute treatment of bipolar depression. The

available evidence from randomized controlled trials is limited and

controversial. Furthermore, traditional randomized controlled trials

are not designed to tell who (of the target population) will benefit

from the intervention - and who might do better without. In addition,

as bipolar disorders are chronic mood disorders, with a series of

interventions being the rule rather than the exception (in case of

bipolar depression, to reach remission), they do not closely mimic

clincial reality as the effects of previous treatments on the efficacy

and tolerability of subsequent treatment are not well

captured. Therefore other methodological approaches are urgently

needed which allow to practice personalized, evidence-based medicine

in patients with bipolar depression.

Dynamic treatment regimes operationalize clinical decision rules as a

sequence of decision rules, one per stage of clinical intervention,

that map up-to-date patient information to a recommended treatment.

Dynamic treatment regimes therefore personalize treatment according

the evolvin