Exploring the Association Between Residual Mood Symptoms and Self-Reported Side Effects in the Euthymic Phase of Bipolar Disorders: A Cross-Sectional Network Analysis.

Introduction

Bipolar disorders (BD) are characterized by mood symptoms that can worsen medication side effects. We aimed to study the association between residual mood signs and self-reported side effects in the euthymic phase of BD.

Methods

We assessed residual mood signs using the Montgomery-Asberg Depression Rating scale (MADRS) and Young Mania Rating scale (YMRS) and self-reported side effects using the Patient-Rated Inventory of Side Effects (PRISE-M) for 880 males and 1369 females with BD. We conducted a network analysis to test the associations between 52 items of the three scales for males and females separately. We then identified clusters of nodes that fit the networks well.

Results

We report only positive associations between residual mood signs and side effects. An elevated mood (YMRS) in females and increased energy (YMRS) in males were central nodes, strongly influencing the development of additional mood symptoms and side effects. Furthermore, we identified three clusters of nodes in both sexes: (1) a "mood cluster", including most YMRS and MADRS items and the PRISE-M items evaluating sedation, sleep, and restlessness, (2) a cluster of nonsexual side effects (mostly PRISE-M items), and (3) a cluster of sexual side effects. In both sexes, we identified bridge nodes that may favor the communication between mood and side effects, namely palpitations (PRISE-M) and agitation (PRISE-M).

Conclusions

The results justify the particular attention of practitioners to monitor elevated moods or increased energy to try to reduce self-reported side effects and other residual mood symptoms in the euthymic phase of BD. Our findings suggest that clinicians could consider patient-reported loss of energy, difficulty in falling asleep, and restlessness as mood symptoms rather than medications' side effects. Palpitations and agitation may contribute to the development of additional mood symptoms or somatic complaints.