Total antioxidant capacity as a predictor of treatment response in bipolar mania: evidence from a 4-week follow-up study

A growing body of clinical evidence suggests that the oxidative stress (OS) hypothesis may play a role in manic episodes of bipolar disorder. However, the underlying mechanisms remain unclear. In this follow-up study, 70 inpatients with manic episodes of bipolar disorder were recruited from Wutai Mountain Hospital in Yangzhou and underwent a 4-week post-treatment follow-up. In addition, 70 age- and sex-matched healthy control (HC) subjects were recruited. All participants underwent a standardized assessment of manic symptoms. The researchers collected peripheral blood samples to measure serum levels of OS markers. In patients with bipolar mania, symptom severity, as measured by YMRS scores, decreased significantly after 4 weeks of treatment (t = 46.220, P < 0.001). Compared with HCs, patients with bipolar mania before treatment exhibited significantly lower CAT, GPx, GSH, H₂O₂ and ·OH levels (all P < 0.05), together with significantly higher TAC levels ( P = 0.014). Following treatment, CAT, GPx, GSH and ·OH levels (all P < 0.05) increased significantly, whereas TAC levels decreased ( P < 0.001). H₂O₂ levels in the patients with bipolar mania after treatment remained significantly lower than those in HCs ( P = 0.005). Correlation analysis demonstrated that the reduction in YMRS scores over the 4-week treatment period was significantly negatively associated with changes in TAC levels ( r = − 0.254, P < 0.05). Furthermore, multivariate linear regression analysis identified baseline YMRS score, the 4-week change in TAC, and sex as a significant predictor of symptom improvement in patients with mania of bipolar disorder (all P < 0.05). This study demonstrated that OS profiles in patients experiencing bipolar mania differ significantly from those of HCs, with TAC emerging as a potential predictor of clinical improvement.