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Döme P, Kunovszki P, Takács P, Fehér L, Balázs T, Dede K, Mulhern-Haughey S, Barbreau S, Rihmer Z. Clinical characteristics of treatment-resistant depression in adults in Hungary: Real-world evidence from a 7-year-long retrospective data analysis. PLoS One 2021; 16:e0245510. [PMID: 33471854 PMCID: PMC7817060 DOI: 10.1371/journal.pone.0245510] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/30/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Treatment-resistant depression (TRD) is associated with a poor quality of life and high economic burden. This observational retrospective epidemiological study aimed to estimate the proportion of patients with TRD within a cohort of patients with major depressive disorder (MDD) in Hungary and examine the mortality and comorbidities of patients with and without TRD. Patients and methods This study included patients with MDD who experienced onset of a new depressive episode between 01 January 2009 and 31 August 2015, using data from a nationwide, longitudinal database. Results Overall, 99,531 patients were included in the MDD cohort, of which 8,268 (8.3%) also met the criteria for TRD. The overall survival of non-TRD patients was longer than in TRD patients; the risk of mortality for TRD patients was significantly higher than of non-TRD patients (HR [CI] 1.381 [1.212–1.571]; p<0.001). Patients with TRD had a significantly higher probability of having “Neurotic, stress-related and somatoform disordersˮ, autoimmune conditions, cardio- or cerebrovascular diseases, thyroid gland diseases and self-harming behaviour not resulting in death than non-TRD patients (for all comparisons, p values were less than 0.005). Discussion To our best knowledge, this is the first study to assess the frequency of TRD in Hungary. In a cohort of Hungarian MDD patients, we have found that the proportion of TRD (~8.3%) is comparable to those reported in previous studies with similar methodology from other countries. The majority of our other main findings (e.g. more frequent self-harming behaviour, increased risk of “Neurotic, stress-related and somatoform disordersˮ and higher overall mortality in TRD subjects) are also in line with previous results from other countries. Taking the substantial proportion of patients with TRD into consideration, a more comprehensive and targeted treatment strategy would be required for these individuals.
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Affiliation(s)
- Péter Döme
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Péter Kunovszki
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
- * E-mail:
| | - Péter Takács
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
| | | | | | | | | | | | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
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Hong W, Zhang C, Xing MJ, Peng DH, Wu ZG, Wang ZW, Chen J, Yuan CM, Su YS, Hu YY, Cao L, Wang Y, Huang J, Lu WH, Yi ZH, Yu X, Zhao JP, Zhang Q, Fang YR. Contribution of long duration of undiagnosed bipolar disorder to high frequency of relapse: A naturalistic study in China. Compr Psychiatry 2016; 70:77-81. [PMID: 27624425 DOI: 10.1016/j.comppsych.2016.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 06/15/2016] [Accepted: 06/19/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND With attention to misdiagnosis of bipolar disorder (BP), long duration of undiagnosed bipolar disorder (DUBP) had been reported recently in years. This study aims to investigate the contributions of long DUBP to the frequency of relapse in bipolar patients, and explore affect factors of DUBP. METHOD From 26 hospitals throughout China, 3896 participants diagnosed with BP according to International Classification of Diseases 10th criteria were enrolled in this study. Socio-demographic and clinical data were collected from medical records and specific questionnaires through clinical interviews with patients and their relatives. RESULTS (1) Our results showed that the mean of DUBP was 40.52months. In total, 779 patients (19.995%) reported DUBP greater than 5years, and 1931 patients (49.564%) reported their DUBP greater than 2years. The number of mood episodes was averaged 5.44, and the frequency ratio of (hypo) mania to depressive episodes was 1.49 (3.27/2.19). (2) Multiple linear regression analysis revealed that DUBP was significantly contributed to the number of relapse (Beta=0.072, p<0.001) after considering the confounding including gender, age at study entry, age of onset, age of first (hypo) manic episodes, age of first depressive episodes, type of first episodes and family history of mental illness. (3) Factors including age at the study entry (Beta=0.526, p<0.001), age of onset (Beta=-1.654, p<0.001), age of first (hypo) manic episode (Beta=0.348, p<0.001), age of first depressive episode (Beta=0.983, p<0.001), depression as the type of first episode (Beta=0.058, p<0.001) and family history of mental illness (Beta=0.029, p<0.05) were significantly contributed to long DUBP. CONCLUSION It was concluded that long DUBP might lead to high frequent relapse in bipolar patients. The factors correlated with long DUBP include older age, early age of onset, depression as the type of first episode and family history of mental illness. The findings of our study suggest emergency task to early reorganization of bipolar disorder, and improving clinicians' recognition of bipolar disorder from patients with depressive episodes, especially in children and adolescents.
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Affiliation(s)
- Wu Hong
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Chen Zhang
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
| | - Meng Juan Xing
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Dai Hui Peng
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Zhi Guo Wu
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Zuo Wei Wang
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China; Division of Mood Disorders, Hongkou District Mental Health Center of Shanghai, Shanghai, P.R. China
| | - Jun Chen
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Cheng Mei Yuan
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - You Song Su
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Ying Yan Hu
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Lan Cao
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Yong Wang
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Jia Huang
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Wei Hong Lu
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Zheng Hui Yi
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Xin Yu
- Institute of Mental Health, Peking University, Beijing, P.R. China
| | - Jing Ping Zhao
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P.R. China
| | - Qinting Zhang
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, Shanghai, P.R. China
| | - Yi Ru Fang
- Division of Mood Disorders, Shanghai Clinical Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China.
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Park YM, Lee BH. Treatment response in relation to subthreshold bipolarity in patients with major depressive disorder receiving antidepressant monotherapy: a post hoc data analysis (KOMDD study). Neuropsychiatr Dis Treat 2016; 12:1221-7. [PMID: 27274258 PMCID: PMC4876090 DOI: 10.2147/ndt.s104188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this observational study was to determine whether subthreshold bipolarity affects treatment response and remission in patients with major depressive disorder receiving antidepressant (AD) monotherapy over a 6-month follow-up period. METHODS Seventy-eight patients with major depressive disorder were stratified into two subgroups according to the presence of subthreshold bipolarity, identified using the Korean version of the Mood Disorder Questionnaire (K-MDQ), which classifies patients as positive for a screening of bipolarity based on the cutoff for the total K-MDQ score (ie, 7 points). They received AD monotherapy such as escitalopram, sertraline, paroxetine, or tianeptine for 6 months. The Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale, and Beck Scale for Suicide Ideation were applied at baseline, 1 week, 3 weeks, 2 months, 3 months, and 6 months. RESULTS The mean HAMD, BDI, and Beck Scale for Suicide Ideation scores were higher in the bipolarity group than in the nonbipolarity group at 3 weeks. The mean BDI score was also higher in the bipolarity group than in the nonbipolarity group at 6 months. Evaluation of the ratio of improvement for each scale revealed different patterns of percentage changes between the two groups over the 6-month follow-up period. Furthermore, the response and remission rates (as assessed using BDI and HAMD scores) were higher in the nonbipolarity group than in the bipolarity group, with the exception of HAMD scores at the 3-week follow-up time point. CONCLUSION The findings of this study showed that depressed patients with bipolarity had a worse response to AD monotherapy than did those without bipolarity.
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Affiliation(s)
- Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Bun-Hee Lee
- Department of Psychiatry, Seoul Eunpyeong Hospital, Seoul, Republic of Korea
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Woo YS, Shim IH, Wang HR, Song HR, Jun TY, Bahk WM. A diagnosis of bipolar spectrum disorder predicts diagnostic conversion from unipolar depression to bipolar disorder: a 5-year retrospective study. J Affect Disord 2015; 174:83-8. [PMID: 25486276 DOI: 10.1016/j.jad.2014.11.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The major aims of this study were to identify factors that may predict the diagnostic conversion from major depressive disorder (MDD) to bipolar disorder (BP) and to evaluate the predictive performance of the bipolar spectrum disorder (BPSD) diagnostic criteria. METHODS The medical records of 250 patients with a diagnosis of MDD for at least 5 years were retrospectively reviewed for this study. RESULTS The diagnostic conversion from MDD to BP was observed in 18.4% of 250 MDD patients, and the diagnostic criteria for BPSD predicted this conversion with high sensitivity (0.870) and specificity (0.917). A family history of BP, antidepressant-induced mania/hypomania, brief major depressive episodes, early age of onset, antidepressant wear-off, and antidepressant resistance were also independent predictors of this conversion. LIMITATIONS This study was conducted using a retrospective design and did not include structured diagnostic interviews. CONCLUSIONS The diagnostic criteria for BPSD were highly predictive of the conversion from MDD to BP, and conversion was associated with several clinical features of BPSD. Thus, the BPSD diagnostic criteria may be useful for the prediction of bipolar diathesis in MDD patients.
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Affiliation(s)
- Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Hee Shim
- Department of Psychiatry, Cancer Center, Dongnam Institute of Radiological & Medical Sciences, Busan, Republic of Korea
| | - Hee-Ryung Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hoo Rim Song
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Youn Jun
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Antidepressant response and subthreshold bipolarity in "unipolar" major depressive disorder: implications for practice and drug research. J Clin Psychopharmacol 2013; 33:449-52. [PMID: 23775059 DOI: 10.1097/jcp.0b013e318299d2d5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Undiagnosed bipolar disorder in patients treated for major depression in China. J Affect Disord 2012; 140:181-6. [PMID: 22397888 DOI: 10.1016/j.jad.2012.02.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/05/2012] [Accepted: 02/05/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a recurrent, complex illness and often misdiagnosed and treated as a major depressive disorder (MDD). This study set out (1) to investigate the proportion of BD in patients treated for MDD using DSM-IV diagnostic criteria; (2) to test the usefulness of the screening tool - the 32-item Hypomania Checklist (HCL-32) in Chinese patients; and (3) to assess whether MDD patients with subthreshold manic features (patients who screened positive for BD on the HCL-32, but did not meet the diagnostic criteria for DSM-IV BD as measured by Mini International Neuropsychiatric Interview (MINI)) differ from those with BD, and from those suffering from MDD without manic features in terms of basic demographic and clinical variables. METHODS A total of 1487 patients treated for MDD were consecutively examined in 13 mental health centers in China. The patients' socio-demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The HCL-32 was self-completed by patients to identify hypomanic symptoms, and the MINI was used by clinicians to establish DSM-IV diagnoses. RESULTS The proportions of undiagnosed BD (all types), BD-I and BD-II were 20.8%, 7.9% and 12.8%, respectively. The HCL-32 had low positive predictive value (0.43). Compared to MDD patients without subthreshold manic features, MDD patients with subthreshold manic features were younger at onset, less likely to be married and had more depressive episodes on a seasonal basis, and more frequent depressive episodes overall. Compared to BD patients, MDD patients with subthreshold manic features had an older age at onset and less frequent depressive episodes and less family history of psychiatric disorders, appetite, weight gain and time spent sleeping, suicide ideation and attempts and psychotic symptoms. CONCLUSIONS At least one fifth of Chinese patients treated for MDD may have an undiagnosed BD. The HCL-32 is useful to identify broader subthreshold bipolar features. The findings need to be confirmed by longitudinal studies using more comprehensive, standardized instruments.
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Bipolarity and inadequate response to antidepressant drugs: clinical and psychopharmacological perspective. J Affect Disord 2012; 136:e13-e19. [PMID: 21621266 DOI: 10.1016/j.jad.2011.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 04/28/2011] [Accepted: 05/08/2011] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The reason why depression may respond poorly to treatment with antidepressant drugs may be connected with the features of bipolarity. Evidence to this effect has accumulated in recent studies of various kinds of depression in mood disorders. Additional evidence for such a connection may be the efficacy of mood-stabilizing drugs in the augmentation of antidepressants in treatment-resistant depression. METHODS This review is based on clinical and psychopharmacological research performed over the past five years. The clinical investigation was based on the response to antidepressants of bipolar depression or to symptoms of hypomania, assessed mainly by the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32). The psychopharmacological research tested the efficacy of augmentation of antidepressants in treatment-resistant depression by mood-stabilizing drugs of the 1st and 2nd generations. RESULTS A number of studies have pointed to an association between bipolar depression, or symptoms of hypomania and an inadequate response to antidepressants. Such a connection was also found in the Polish TRES-DEP study which included 1051 depressed patients. Pharmacological studies have demonstrated the efficacy of first generation mood-stabilizing drugs (lithium, carbamazepine) and second generation drugs (quetiapine, olanzapine, risperidone, ziprasidone, lamotrigine) for augmentation of antidepressants in treatment-resistant depression. Some evidence has been presented that mixed depressive episodes may also belong to this category. CONCLUSIONS The results of these clinical and psychopharmacological studies appear to confirm an association between bipolarity and a poor response of depression to treatment with antidepressant drugs.
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Jabben N, Penninx BWJH, Beekman ATF, Smit JH, Nolen WA. Co-occurring manic symptomatology as a dimension which may help explaining heterogeneity of depression. J Affect Disord 2011; 131:224-32. [PMID: 21295859 DOI: 10.1016/j.jad.2010.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 12/13/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The dichotomous distinction between unipolar and bipolar disorders may be challenged by heterogeneity within diagnoses and overlap between different diagnoses. A broad mood disorder category in which patients differ as a result of variation along separate manic and depressive mood dimensions can be proposed. To test this, it is hypothesized that heterogeneity in clinical and other features of subjects selected for unipolar depression can be partly explained by coexisting manic symptoms. METHODS A cohort selected for unipolar depressive disorder was followed up for two years at which time co-occurring manic symptoms were assessed, yielding four groups with increasing manic symptomatology: i) pure unipolar depressive disorder (n=1598), ii) unipolar depressive disorder with subthreshold manic symptomatology (n=64), iii) bipolar II disorder (n=39), and iv) bipolar I disorder (n=86). Multivariate logistic regression and analyses of covariance controlled for depression severity were used to investigate whether patients with increasing manic symptomatology could be differentiated from patients with pure depressive disorder. RESULTS Male gender, a lower age at first episode, a history of suicide attempts and increased aggressive cognitions were independently associated with an increase in manic symptoms. The additional presence of (hypo)mania was associated with greater depression severity and more disability than pure depressive disorder. LIMITATIONS The groups with manic symptomatology (subthreshold, hypomania and mania) were considerably smaller compared to the pure depression group. CONCLUSIONS The heterogeneity in depressive illness can be partly explained by the coexisting variation along the manic symptom dimension. Co-occurring manic symptoms should be taken into account in depression and a symptom dimensional approach of mood disorders may provide phenotypes that are more informative than current mood disorder categories.
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Affiliation(s)
- Nienke Jabben
- Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Rybakowski J, Dudek D, Pawlowski T, Lojko D, Siwek M, Kiejna A. Use of the Hypomania Checklist-32 and the Mood Disorder Questionnaire for detecting bipolarity in 1,051 patients with major depressive disorder. Eur Psychiatry 2011; 27:577-81. [DOI: 10.1016/j.eurpsy.2010.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 12/03/2010] [Accepted: 12/05/2010] [Indexed: 10/18/2022] Open
Abstract
AbstractPurposeTo use the Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ), for detecting bipolarity in depressed patients.PatientsOne thousand and fifty-one patients fulfilling ICD-10 criteria for unipolar major depressive episode, single or recurrent, were studied. Patients were assessed using a structured demographic and clinical data interview, and by the Polish versions of the HCL-32 and MDQ questionnaires.ResultsHypomanic symptoms exceeding cut-off criteria for bipolarity by HCL-32 were found in 37.5% of patients and, by MDQ, in 20% of patients. Patients with HCL-32 (+) or MDQ (+) differed significantly from patients with HCl-32 (−) and MDQ (−) respectively, by being less frequently married, having more family history of depression, bipolar disorder, alcoholism and suicide, earlier onset of illness, and more depressive episodes and psychiatric hospitalizations. The percentage of patients resistant to treatment with antidepressant drugs was significantly higher in HCL-32 (+) vs HCL-32 (−) and in MDQ (+) vs MDQ (−): 43.9% vs 30.0%, and 26.4% vs 12.4%, respectively.ConclusionsThe results confirm a substantial percentage of bipolarity in major depressive disorder. Such patients have a number of clinical characteristics pointing on a more severe form of the illness and their depression is more resistant to treatment with antidepressants.
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Antidepressant-resistant depression and antidepressant-associated suicidal behaviour: the role of underlying bipolarity. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:906462. [PMID: 21603142 PMCID: PMC3096313 DOI: 10.1155/2011/906462] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 02/08/2011] [Indexed: 11/26/2022]
Abstract
The complex relationship between the use of antidepressants and suicidal behaviour is one of the hottest topics of our contemporary psychiatry. Based on the literature, this paper summarizes the author's view on antidepressant-resistant depression and antidepressant-associated suicidal behaviour. Antidepressant-resistance, antidepressant-induced worsening of depression, antidepressant-associated (hypo)manic switches, mixed depressive episode, and antidepressant-associated suicidality among depressed patients are relatively most frequent in bipolar/bipolar spectrum depression and in children and adolescents. As early age at onset of major depressive episode and mixed depression are powerful clinical markers of bipolarity and the manic component of bipolar disorder (and possible its biological background) shows a declining tendency with age antidepressant-resistance/worsening, antidepressant-induced (hypo)manic switches and "suicide-inducing" potential of antidepressants seem to be related to the underlying bipolarity.
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Kiejna A, Pawłowski T, Dudek D, Lojko D, Siwek M, Roczeń R, Rybakowski JK. The utility of Mood Disorder Questionnaire for the detection of bipolar diathesis in treatment-resistant depression. J Affect Disord 2010; 124:270-4. [PMID: 20060173 DOI: 10.1016/j.jad.2009.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 11/30/2009] [Accepted: 12/01/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatment-resistant depression is a heterogeneous entity. There are many variables associated with poor response to antidepressants, one of which is missed bipolarity. Therefore, the present study investigated the bipolar diathesis between patients with treatment-resistant (TR) depression and non-treatment-resistant (NTR) depression as assessed with the Mood Disorder Questionnaire (MDQ). METHOD The population studied included 1051 patients diagnosed with single or recurrent major depressive disorder. They were classified into a non-treatment-resistant group (481 patients) and a treatment-resistant group (570 patients). The psychiatrist, using information from the patient's medical history, psychiatric examination and available documentation, assessed each eligible patient. The symptoms of bipolarity were additionally assessed by the Mood Disorder Questionnaire. RESULTS A positive screen on the MDQ defined as endorsement of at least 6 of the 13 yes or no questions was an independent risk factor for treatment resistance.The total MDQ score was significantly higher in TR vs NTR (4.33 vs 2.66 points p<0.001) and the percentage of patients screened positive was significantly higher in TR than in NTR (13.7% vs 5.6% p<0.001). Factor analysis resulted in 2 factors with eigenvalues >1 explaining 91.5% of total variance. CONCLUSIONS Using the MDQ scale we confirmed the association between bipolarity and worse response to antidepressant drugs in patients with major depressive disorder.
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Affiliation(s)
- Andrzej Kiejna
- Department of Psychiatry, Medical University of Wroclaw, Wroclaw, Poland
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Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Möller HJ, Kasper S. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2010 on the treatment of acute bipolar depression. World J Biol Psychiatry 2010; 11:81-109. [PMID: 20148751 DOI: 10.3109/15622970903555881] [Citation(s) in RCA: 228] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES These guidelines are based on a first edition that was published in 2002, and have been edited and updated with the available scientific evidence until September 2009. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the treatment of acute bipolar depression in adults. METHODS The data used for these guidelines have been extracted from a MEDLINE and EMBASE search, from the clinical trial database clinicaltrials.gov, from recent proceedings of key conferences, and from various national and international treatment guidelines. Their scientific rigor was categorised into six levels of evidence (A-F). As these guidelines are intended for clinical use, the scientific evidence was finally assigned different grades of recommendation to ensure practicability. RESULTS We identified 10 pharmacological monotherapies or combination treatments with at least limited positive evidence for efficacy in bipolar depression, several of them still experimental and backed up only by a single study. Only one medication was considered to be sufficiently studied to merit full positive evidence. CONCLUSIONS Although major advances have been made since the first edition of this guideline in 2002, there are many areas which still need more intense research to optimize treatment. The majority of treatment recommendations is still based on limited data and leaves considerable areas of uncertainty.
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Affiliation(s)
- Heinz Grunze
- Newcastle University, RVI, Division of Psychiatry, Institute of Neuroscience, Newcastle upon Tyne, UK.
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