***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE This investigation compared the efficacy of the monoamine oxidase inhibitor ( MAOI ) tranylcypromine with that of the tricyclic imipramine in the treatment of anergic bipolar depressive illness . METHOD A controlled , double-blind comparison was used to study 56 out patients who met operationalized criteria for anergic bipolar depression . Patients with bipolar I and II depression were equally distributed between comparison groups . Outcome was measured by the patient-rated Beck Depression Inventory and the clinician-rated Hamilton Rating Scale for Depression , Raskin Mania and Depression Scales , Clinical Global Impression Scale , and the Pittsburgh Reversed Vegetative Symptom Scale .  Twenty-eight patients were treated with tranylcypromine and 28 with imipramine .  Seventy-three percent of bipolar depressive patients screened for the study met criteria for anergic depression , consistent with previous findings from studies in bipolar illness that stretch back over 100 years . RESULTS Tranylcypromine produced statistically significant superior outcome in terms of lower attrition , greater symptomatic improvement , and higher global response without increased risk of treatment-emergent hypomania or mania . CONCLUSIONS The authors propose that the apparently superior efficacy of tranylcypromine in bipolar depression is specifically linked to anergia and reversed neurovegetative symptoms . Bipolar I and bipolar II patients had comparable outcomes , but bipolar I patients had a significantly greater risk of treatment-emergent mood swings . Although the relatively poor showing of imipramine warrants close scrutiny , these findings provide further documentation of the utility of MAOIs in patients presenting with anergia , motor  retardation  , hyperphagia , and /or hypersomnia BACKGROUND To our knowledge , this is the first prospect i ve natural history study of weekly symptomatic status of patients with bipolar I disorder ( BP-I ) during long-term follow-up . METHODS Analyses are based on ongoing prospect i ve follow-up of 146 patients with Research Diagnostic Criteria BP-I , who entered the National Institute of Mental Health ( Bethesda , Md ) Collaborative Depression Study from 1978 through 1981 .  Weekly affective symptom status ratings were analyzed by polarity and severity , ranging from asymptomatic , to subthreshold levels , to full-blown major depression and mania . Percentages of follow-up weeks at each level as well as number of shifts in symptom status and polarity during the entire follow-up period were examined . Finally , 2 new measures of chronicity were evaluated in relation to previously identified predictors of chronicity for BP-I. RESULTS Patients with BP-I were symptomatically ill 47.3 % of weeks throughout a mean of 12.8 years of follow-up . Depressive symptoms ( 31.9 % of total follow-up weeks ) predominated over manic/hypomanic symptoms ( 8.9 % of weeks ) or cycling/mixed symptoms ( 5.9 % of weeks ) . Subsyndromal , minor depressive , and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms ( 29.9 % vs 11.2 % of weeks , respectively ) . Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year . Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up , as did comorbid drug-use disorder . CONCLUSIONS The longitudinal weekly symptomatic course of BP-I is chronic . Overall , the symptomatic structure is primarily depressive rather than manic , and subsyndromal and minor affective symptoms predominate . Symptom severity levels fluctuate , often within the same patient over time . Bipolar I disorder is expressed as a dimensional illness featuring the full range ( spectrum ) of affective symptom severity and polarity OBJECTIVE To determine the relative efficacy , tolerability and risk of precipitating mania of moclobemide and imipramine in the treatment of bipolar depression . METHOD A r and omized , double-blind , parallel group , multicentre study of moclobemide ( MCB ) ( 450 - 750 mg daily ) and imipramine ( IMI ) ( 150 - 250 mg daily ) in 21 centres in nine countries ; 156 patients ( 65 males , 91 females ) aged 18 - 65 with bipolar depression ( 17-item Hamilton Depression Rating Scale ( HAMD ) score chi16 ) participated . Clinical status was assessed using st and ardized rating scales before treatment and at 1,2,3,4,6 and 8 weeks . The data were analysed on an intention to treat basis with the last observation carried forward . RESULTS In the MCB group , the mean HAMD fell from 23.0 to 13.1 , in the IMI group it fell from 22.5 to 9.5 ; the mean score on the Montgomery-Asberg Depression Rating Scale ( MADRS ) fell from 29.5 to 16.3 on MCB and from 29.2 to 11.6 on IMI . There were no statistically significant differences between the two groups on any efficacy measures . Anticholinergic side-effects were three times more common with IMI than MCB and weight gain was also greater on IMI . Two patients ( 3.7 % ) on MCB and six patients ( 11 % ) on IMI were withdrawn because of manic symptoms , with manic symptoms occurring earlier on IMI , although these differences did not reach statistical significance . CONCLUSION No differences in efficacy were detected between MCB and IMI in the treatment of bipolar depression . The data suggests that MCB is less likely than IMI to precipitate mania OBJECTIVE The aim of this study was to evaluate the efficacy and tolerability of quetiapine and paroxetine monotherapy for major depression in bipolar disorder . METHOD 740 patients ( 478 bipolar I , 262 bipolar II ) with major depressive episodes ( DSM-IV ) were r and omly assigned to quetiapine 300 mg/d ( n = 245 ) , quetiapine 600 mg/d ( n = 247 ) , paroxetine 20 mg/d ( n = 122 ) , or placebo ( n = 126 ) for 8 weeks . The primary end point was the change from baseline in Montgomery-Asberg Depression Rating Scale ( MADRS ) total score . The study was conducted from May 2005 to May 2007 . RESULTS Mean MADRS score change from baseline at 8 weeks was -16.19 for quetiapine 300 mg , -16.31 for quetiapine 600 mg , -13.76 for paroxetine , and -12.60 for placebo ( P < .001 for both quetiapine doses , P = .313 for paroxetine , vs placebo ) . Quetiapine-treated ( both doses ) , but not paroxetine-treated , patients showed significantly greater improvements ( P < or = .05 ) in most secondary outcomes measures at week 8 versus the placebo group . Paroxetine significantly improved Hamilton Anxiety Rating Scale scores versus placebo ( P < .05 ) but not MADRS or Hamilton Depression Rating Scale ( HDRS ) scores . Both quetiapine doses were associated with greater improvements than paroxetine for MADRS and HDRS scores . The most common adverse events were dry mouth , somnolence , sedation , and dizziness with quetiapine ( both doses ) and dry mouth , sedation , headache , insomnia , and nausea with paroxetine . The incidence of treatment-emergent mania/hypomania was lower with quetiapine compared with paroxetine and placebo . CONCLUSIONS Quetiapine ( 300 or 600 mg/d ) , but not paroxetine , was more effective than placebo for treating acute depressive episodes in bipolar I and II disorder . Quetiapine treatment was generally well tolerated . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00119652 CONTEXT Evidence of psychosocial disability in bipolar disorder is based primarily on bipolar I disorder ( BP-I ) and does not relate disability to affective symptom severity and polarity or to bipolar II disorder ( BP-II ) . OBJECTIVE To provide detailed data on psychosocial disability in relation to symptom status during the long-term course of BP-I and BP-II . DESIGN A naturalistic study with 20 years of prospect i ve , systematic follow-up . SETTING Inpatient and outpatient treatment facilities at 5 US academic centers . Patients One hundred fifty-eight patients with BP-I and 133 patients with BP-II who were followed up for a mean ( SD ) of 15 ( 4.8 ) years in the National Institute of Mental Health Collaborative Depression Study . MAIN OUTCOME MEASURES The relationship , by r and om regression , between Range of Impaired Functioning Tool psychosocial impairment scores and affective symptom status in 1-month periods during the long-term course of illness from 6-month and yearly Longitudinal Interval Follow-up Evaluation interviews . RESULTS Psychosocial impairment increases significantly with each increment in depressive symptom severity for BP-I and BP-II and with most increments in manic symptom severity for BP-I. Subsyndromal hypomanic symptoms are not disabling in BP-II , and they may even enhance functioning . Depressive symptoms are at least as disabling as manic or hypomanic symptoms at corresponding severity levels and , in some cases , significantly more so . At each level of depressive symptom severity , BP-I and BP-II are equally impairing . When asymptomatic , patients with bipolar disorder have good psychosocial functioning , although it is not as good as that of well controls . CONCLUSIONS Psychosocial disability fluctuates in parallel with changes in affective symptom severity in BP-I and BP-II . Important findings for clinical management are the following : ( 1 ) depressive episodes and symptoms , which dominate the course of BP-I and BP-II , are equal to or more disabling than corresponding levels of manic or hypomanic symptoms ; ( 2 ) subsyndromal depressive symptoms , but not subsyndromal manic or hypomanic symptoms , are associated with significant impairment ; and ( 3 ) subsyndromal hypomanic symptoms appear to enhance functioning in BP-II BACKGROUND This is the first prospect i ve longitudinal study , to our knowledge , of the natural history of the weekly symptomatic status of bipolar II disorder ( BP-II ) . METHODS Weekly affective symptom status ratings for 86 patients with BP-II were based on interviews conducted at 6- or 12-month intervals during a mean of 13.4 years of prospect i ve follow-up . Percentage of weeks at each symptom severity level and the number of shifts in symptom status and polarity were examined . Predictors of chronicity for BP-II were evaluated using new chronicity measures . Chronicity was also analyzed in relation to the percentage of follow-up weeks with different types of somatic treatment . RESULTS Patients with BP-II were symptomatic 53.9 % of all follow-up weeks : depressive symptoms ( 50.3 % of weeks ) dominated the course over hypomanic ( 1.3 % of weeks ) and cycling/mixed ( 2.3 % of weeks ) symptoms . Subsyndromal , minor depressive , and hypomanic symptoms combined were 3 times more common than major depressive symptoms . Longer intake episodes , a family history of affective disorders , and poor previous social functioning predicted greater chronicity . Prescribed somatic treatment did not correlate significantly with symptom chronicity .  Patients with BP-II of brief ( 2 - 6 days ) vs longer ( > or = 7 days ) hypomanias were not significantly different on any measure . CONCLUSIONS The longitudinal symptomatic course of BP-II is chronic and is dominated by depressive rather than hypomanic or cycling/mixed symptoms . Symptom severity fluctuates frequently within the same patient over time , involving primarily symptoms of minor and subsyndromal severity . Longitudinally , BP-II is expressed as a dimensional illness involving the full severity range of depressive and hypomanic symptoms . Hypomania of long or short duration in BP-II seems to be part of the same disease process The Clinical Global Impressions Scale ( CGI ) was modified specifically for use in assessing global illness severity and change in patients with bipolar disorder . Criticisms of the original CGI were addressed by correcting inconsistencies in scaling , identifying time frames for comparison , clarifying definitions of illness severity and change , and separating out assessment of treatment side effects from illness improvement during treatment . A Detailed User 's Guide was developed to train clinicians in the use of the new CGI-Bipolar Version ( CGI-BP ) for rating severity of manic and depressive episodes and the degree of change from the immediately preceding phase and from the worst phase of illness . The revised scale and manual provide a focused set of instructions to facilitate the reliability of these ratings of mania , depression , and overall bipolar illness during treatment of an acute episode or in longer-term illness prophylaxis . Interrater reliability of the scale was demonstrated in preliminary analyses . Thus , the modified CGI-BP is anticipated to be more useful than the original CGI in studies of bipolar disorder OBJECTIVE Few 
    Output:
    
This systematic review provides evidence for the efficacy and safety of tranylcypromine treatment in bipolar depression .