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Yang R, Zhao Y, Tan Z, Lai J, Chen J, Zhang X, Sun J, Chen L, Lu K, Cao L, Liu X. Differentiation between bipolar disorder and major depressive disorder in adolescents: from clinical to biological biomarkers. Front Hum Neurosci 2023; 17:1192544. [PMID: 37780961 PMCID: PMC10540438 DOI: 10.3389/fnhum.2023.1192544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Background Mood disorders are very common among adolescents and include mainly bipolar disorder (BD) and major depressive disorder (MDD), with overlapping depressive symptoms that pose a significant challenge to realizing a rapid and accurate differential diagnosis in clinical practice. Misdiagnosis of BD as MDD can lead to inappropriate treatment and detrimental outcomes, including a poorer ultimate clinical and functional prognosis and even an increased risk of suicide. Therefore, it is of great significance for clinical management to identify clinical symptoms or features and biological markers that can accurately distinguish BD from MDD. With the aid of bibliometric analysis, we explore, visualize, and conclude the important directions of differential diagnostic studies of BD and MDD in adolescents. Materials and methods A literature search was performed for studies on differential diagnostic studies of BD and MDD among adolescents in the Web of Science Core Collection database. All studies considered for this article were published between 2004 and 2023. Bibliometric analysis and visualization were performed using the VOSviewer and CiteSpace software. Results In total, 148 publications were retrieved. The number of publications on differential diagnostic studies of BD and MDD among adolescents has been generally increasing since 2012, with the United States being an emerging hub with a growing influence in the field. Boris Birmaher is the top author in terms of the number of publications, and the Journal of Affective Disorders is the most published journal in the field. Co-occurrence analysis of keywords showed that clinical characteristics, genetic factors, and neuroimaging are current research hotspots. Ultimately, we comprehensively sorted out the current state of research in this area and proposed possible research directions in future. Conclusion This is the first-ever study of bibliometric and visual analyses of differential diagnostic studies of BD and MDD in adolescents to reveal the current research status and important directions in the field. Our research and analysis results might provide some practical sources for academic scholars and clinical practice.
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Affiliation(s)
- Ruilan Yang
- CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong, China
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yanmeng Zhao
- Southern Medical University, Guangzhou, Guangdong, China
| | - Zewen Tan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Juan Lai
- CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong, China
| | - Jianshan Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaofei Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiaqi Sun
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lei Chen
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kangrong Lu
- School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Liping Cao
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xuemei Liu
- CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong, China
- University of Chinese Academy of Sciences, Beijing, China
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Mazo GE, Kasyanov ED, Nikolishin AE, Rukavishnikov GV, Shmukler AB, Golimbet VE, Neznanov NG, Kibitov AO. [Family history of affective disorders, the gender factor and clinical characteristics of depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:75-83. [PMID: 34405661 DOI: 10.17116/jnevro202112105275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Analysis of clinical features of development and course of depression in patients with FH of mood disorders taking into account sex differences. MATERIAL AND METHODS This multicenter cross-sectional study included patients over 18 years of age with depressive episode/recurrent depressive disorder. Clinical characteristics of depression, presence of comorbid mental illness and family history (FH) information were obtained in a structured clinical interview. RESULTS One hundred and seventy-one patients (mean age (M (SD)) 40.87 (15.86) y.o.), including 64.5% of women, were enrolled in the study. FH was revealed in 30.2% of patients. The proportion of FH did not differ in men and women (p=0.375). Generalized anxiety disorder (GAD) was more frequent in FH positive patients (p=0.016). Logistic regression also revealed that FH is a risk factor for concomitant GAD (p=0.019, OR=2.4). The GLM demonstrated a significant joint effect of FH and sex on the maximum duration of a depressive episode (p=0.044), as well on the number of suicide attempts (p=0.055) and the number of depressive episodes as a trend (p=0.072). CONCLUSION We have demonstrated the specific interaction of FH of mood disorders with sex on clinical course of depression. Thus, the manifestation of a genetic influence on the clinical phenotype of depression can be significantly moderated by sex.
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Affiliation(s)
- G E Mazo
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia
| | - E D Kasyanov
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Saint-Petersburg State University Pirogov Clinic of High Medical Technologies, St. Petersburg, Russia
| | - A E Nikolishin
- Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russia
| | - G V Rukavishnikov
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia
| | - A B Shmukler
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russia
| | - V E Golimbet
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Mental Health Research Center, Moscow, Russia
| | - N G Neznanov
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russia
| | - A O Kibitov
- Bekhterev National Medical Research Center For Psychiatry And Neurology, St Petersburg, Russia.,Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russia
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Szmulewicz AG, Angriman F, Samamé C, Ferraris A, Vigo D, Strejilevich SA. Dopaminergic agents in the treatment of bipolar depression: a systematic review and meta-analysis. Acta Psychiatr Scand 2017; 135:527-538. [PMID: 28256707 DOI: 10.1111/acps.12712] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To systematically examine the effects of dopaminergic agents (modafinil, armodafinil, pramipexole, methylphenidate, and amphetamines) on bipolar depression outcomes. METHODS Meta-analysis of randomized controlled trials was performed to assess the efficacy and safety of treatment with dopaminergic agents in bipolar depression. In a secondary analysis, findings from both randomized controlled trials and high-quality observational studies were pooled by means of meta-analytic procedures to explore dopaminergic treatment-related new mania. RESULTS Nine studies (1716 patients) were included in our meta-analysis of randomized controlled trials. Treatment with dopaminergic agents for bipolar depression was associated with an increase in both response (1671 individuals, RR 1.25, 95% CI 1.05 to 1.50) and remission rates (1671 individuals, RR 1.40, 95% CI 1.14, 1.71). There was no evidence of an increased risk of mood switch associated with this treatment (1646 individuals, RR 0.96, 95% CI 0.49, 1.89). Our secondary analysis (1231 individuals) yielded a cumulative incidence of mood switch of 3% (95% CI 1.0, 5.0) during a mean follow-up period of 7.5 months. CONCLUSIONS Preliminary findings suggest that dopaminergic agents may represent a useful alternative for the treatment of bipolar depression, with no evidence for a related increase in the risk of mood destabilization during short-term follow-up.
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Affiliation(s)
- A G Szmulewicz
- Hospital de Emergencias Psiquiátricas Torcuato de Alvear, Buenos Aires, Argentina.,Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina.,Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - F Angriman
- Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.,Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C Samamé
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - A Ferraris
- Pharmacology Department, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - D Vigo
- Global Health Systems Cluster, Harvard TH Chan School of Public Health, Boston, MA, USA.,International Consortium for Bipolar Disorder Research, Mc Lean Hospital, Belmont, MA, USA.,Center for Applied Research in Mental Health and Addictions, Simon Fraser University, Vancouver, Canada
| | - S A Strejilevich
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina.,Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina
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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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Lee SH, Park YC, Yoon S, Kim JI, Hahn SW. Clinical implications of loudness dependence of auditory evoked potentials in patients with atypical depression. Prog Neuropsychopharmacol Biol Psychiatry 2014; 54:7-12. [PMID: 24865151 DOI: 10.1016/j.pnpbp.2014.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/08/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The loudness dependence of auditory evoked potentials (LDAEP) has been proposed as a useful biomarker of serotonin activity, and the LDAEP value is low in patients with melancholic depression. In this study, we evaluated LDAEP levels in patients with atypical depression. METHODS We recruited 53 patients with atypical depression and 68 patients with non-atypical depression. Subjects were evaluated by the Atypical Depression Diagnostic Scale (ADDS), Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA), Beck Scale for Suicidal Ideation (BSI), Behavioral Inhibition System and Behavioral Activation System (BIS/BAS) scales, and Hypomanic Personality Scale (HPS). To determine LDAEP, the peak-to-peak N1/P2 was measured at five stimulus intensities and the LDAEP was calculated as the linear-regression slope. RESULTS Patients with atypical depression had stronger LDAEP values and higher BAS and HPS scores than those with non-atypical depression. LDAEP showed a pattern of gradual decrease according to ADDS score hierarchy in patients with major depressive disorder. In the atypical depression group, LDAEP showed significant negative correlation with the BSI score and significant positive correlation with BAS score. In the non-atypical depression group, LDAEP did not show any significant correlations with the scores of psychological scales. CONCLUSIONS Our results suggest that there is a relatively deficient serotonergic activity in patients with atypical depression and that LDAEP reflects mood reactivity. The transient drop of serotonergic activity induced by mood vulnerability might contribute to suicidal tendencies in patients with atypical depression.
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Affiliation(s)
- Seung-Hwan Lee
- Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Juhwa-ro 170, Ilsanseo-gu, Goyang, Republic of Korea; Clinical Emotion and Cognition Research Laboratory, Juhwa-ro 170, Ilsanseo-gu, Goyang, Republic of Korea
| | - Young-Cheon Park
- Clinical Emotion and Cognition Research Laboratory, Juhwa-ro 170, Ilsanseo-gu, Goyang, Republic of Korea
| | - Sunkyung Yoon
- Clinical Emotion and Cognition Research Laboratory, Juhwa-ro 170, Ilsanseo-gu, Goyang, Republic of Korea
| | - Jeong-In Kim
- Clinical Emotion and Cognition Research Laboratory, Juhwa-ro 170, Ilsanseo-gu, Goyang, Republic of Korea
| | - Sang Woo Hahn
- Department of Psychiatry, Soonchunhyang University of College of Medicine, 22, Daesagwan-gil, Yongsan-gu, Seoul, Republic of Korea.
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Tesli M, Espeseth T, Bettella F, Mattingsdal M, Aas M, Melle I, Djurovic S, Andreassen OA. Polygenic risk score and the psychosis continuum model. Acta Psychiatr Scand 2014; 130:311-7. [PMID: 24961959 DOI: 10.1111/acps.12307] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Schizophrenia (SZ) and bipolar disorder (BD) are heritable, polygenic disorders with shared clinical characteristics and genetic risk indicating a psychosis continuum. This is the first study using polygenic risk score (PGRS) to investigate the localization of diagnostic subcategories along the entire psychosis spectrum. METHOD Based on results from the Psychiatric Genomics Consortium (PGC), we assigned a SZ and BD PGRS to each individual in our independent sample [N=570 BD spectrum cases, 452 SZ spectrum cases and 415 healthy controls (CTR)]. Potential differences in mean SZ and BD PGRS across diagnostic spectrums and subcategories were explored. RESULTS SZ and BD PGRSs were significantly associated with both SZ and BD spectrums compared with CTR. For the subcategories, SZ PGRS was significantly associated with SZ, schizoaffective disorder, psychosis not otherwise specified, and BD1, while BD PGRS was significantly associated with BD1 and BD2. There were no significant differences between any of the diagnostic spectrums or subgroups for neither the SZ nor BD PGRS. Lifetime psychosis was significantly associated with SZ PGRS but not with BD PGRS. CONCLUSION These findings further support the psychosis continuum model and provide molecular polygenetic validation of the localization of diagnostic subcategories within this continuum.
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Affiliation(s)
- M Tesli
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Dervic K, Garcia-Amador M, Sudol K, Freed P, Brent DA, Mann JJ, Harkavy-Friedman JM, Oquendo MA. Bipolar I and II versus unipolar depression: clinical differences and impulsivity/aggression traits. Eur Psychiatry 2014; 30:106-13. [PMID: 25280430 DOI: 10.1016/j.eurpsy.2014.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 06/12/2014] [Accepted: 06/29/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular. METHODS Six hundred and eighty-five (n=685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n=455), Bipolar I (BP-I) disorder (n=151), and Bipolar II (BP-II) (n=79) disorder were compared in terms of their socio-demographic and clinical characteristics. RESULTS Compared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients. CONCLUSION Our findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.
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Affiliation(s)
- K Dervic
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA; Department of Psychiatry and Behavioral Science, College of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - M Garcia-Amador
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - K Sudol
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA
| | - P Freed
- 286, Madison Ave, New York, NY 10016, USA
| | - D A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J J Mann
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA
| | | | - M A Oquendo
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute and Columbia University, 1051, Riverside Drive, NY 10032, New York, USA.
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Clinical differences between unipolar and bipolar depression: interest of BDRS (Bipolar Depression Rating Scale). Compr Psychiatry 2013; 54:605-10. [PMID: 23375261 DOI: 10.1016/j.comppsych.2012.12.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/17/2012] [Accepted: 12/31/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES It is currently assumed that there are no important differences between the clinical presentations of unipolar and bipolar depression. Failure to distinguish bipolar from unipolar depression may lead to inappropriate treatment and poorer outcomes. We hereby compare unipolar and bipolar depressed subjects, in order to identify distinctive clinical specificities of bipolar depression. METHODS Two independent samples of depressed patients (unipolar and bipolar) were recruited, with 55 patients in one sample, and 49 in the other. In both samples, unipolar and bipolar patients were compared on a broad range of parameters, including sociodemographic characteristics, comorbidities, Montgomery and Asberg Depression Scale (MADRS; assessing depression severity), CORE (assessing psychomotor disturbance) and Bipolar Depression Rating Scale (assessing specific bipolar depression symptoms). RESULTS Results were similar in both samples. MADRS scores were similar in bipolar and unipolar subjects (median score 33 vs 34; p=0.74). On the CORE, there was a trend to higher scores among the bipolar subjects. BDRS scores were higher in bipolar than in unipolar subjects (median score 33 vs 27; p<0.001). The difference was particularly marked on the "mixed" subscale of the BDRS. We tested the ability of the mixed subscale of the BDRS to distinguish bipolar from unipolar depression, using different cut off points: a cut off point of 3 can predict bipolar depression, with a sensibility of 62% and a specificity of 82%. CONCLUSIONS Presence of mixed symptoms during a depressive episode is in favour of bipolar depression. The BDRS scale should be integrated in a probabilistic approach to distinguish bipolar from unipolar depression.
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Burgos G, Rivera F. The (In)Significance of Race and Discrimination among Latino Youth: The Case of Depressive Symptoms. ACTA ACUST UNITED AC 2012; 42:152-171. [PMID: 23559683 DOI: 10.1080/00380237.2009.10571348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite the growing population of Latinos in the United States, there is little research that explores how discrimination affects the mental health of Latino youth along racial lines. In this paper we ask two closely related questions. First, do black Latino youth have higher or lower symptoms of depression than nonblack Latinos? Second, is the relationship between race and depression among Latino youth buffered by discrimination stress? Results from the Transitions Study show that black Latino youth have significantly higher symptoms of depression than nonblack Latinos. The relationship between race and depression depends on daily-but not on lifetime-experiences of discrimination. The combined effect of race and discrimination holds in the face of a wide range of measures of stress, including major lifetime events, recent life events, and chronic stressors. These findings encourage future research that considers the mental health effects of racial variation among Latinos.
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Perugi G, Fornaro M, Maremmani I, Canonico PL, Carbonatto P, Mencacci C, Muscettola G, Pani L, Torta R, Vampini C, Parazzini F, Dumitriu A, Angst J. Discriminative hypomania checklist-32 factors in unipolar and bipolar major depressive patients. Psychopathology 2012; 45:390-8. [PMID: 22890230 DOI: 10.1159/000338047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 03/13/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although manic or hypomanic episodes define bipolar disorder (BD), most patients show a predominance of depressive symptomatology, often associated with delayed or disregarded BD diagnosis. The Hypomania Checklist-32 (HCL-32) has therefore been developed and tested internationally to facilitate BD recognition. SAMPLING AND METHODS Five hundred seventy-one (563 eligible) patients diagnosed with a major depressive episode according to DSM-IV criteria were consecutively enrolled in a cross-sectional, multicenter, observational study (Come To Me). Lifetime manic or hypomanic features were assessed by the HCL-32, and severity of depressive and anxious symptomatology was assessed using the Zung's self-report questionnaires for depression and anxiety. RESULTS Among the patients diagnosed with BD (n = 119), either type I or type II, the occurrence of (hypo)manic symptoms was significantly higher compared to major depressive disorder (MDD) symptoms according to HCL-32 total and subscale scores obtained using a score of 14, which ensured an optimal discrimination between BD and MDD with a sensitivity of 0.85 and a specificity of 0.78. CONCLUSIONS Although some false positives might occur, the HCL-32 was confirmed to be a useful instrument in the detection of past hypomania in MDD patients, finally contributing to proper therapeutic choices.
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Affiliation(s)
- Giulio Perugi
- Department of Psychiatry, University of Pisa, Pisa, Italy.
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Souery D, Zaninotto L, Calati R, Linotte S, Mendlewicz J, Sentissi O, Serretti A. Depression across mood disorders: review and analysis in a clinical sample. Compr Psychiatry 2012; 53:24-38. [PMID: 21414619 DOI: 10.1016/j.comppsych.2011.01.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 01/20/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES In this article we aimed to: (1) review literature concerning the clinical and psychopathologic characteristics of Bipolar (BP) depression; (2) analyze an independent sample of depressed patients to identify any demographic and/or clinical feature that may help in differentiating mood disorder subtypes, with special attention to potential markers of bipolarity. METHODS A sample of 291 depressed subjects, including BP -I (n = 104), BP -II (n = 64), and unipolar (UP) subjects with (n = 53) and without (n = 70) BP family history (BPFH), was examined to evidence potential differences in clinical presentation and to validate literature-derived markers of bipolarity. Demographic and clinical variables and, also, single items from the Hamilton Depression Rating Scale (HDRS), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS) were compared among groups. RESULTS UP subjects had an older age at onset of mood symptoms. A higher number of major depressive episodes and a higher incidence of lifetime psychotic features were found in BP subjects. Items expressing depressed mood, depressive anhedonia, pessimistic thoughts, and neurovegetative symptoms of depression scored higher in UP, whereas depersonalization and paranoid symptoms' scores were higher in BP. When compared with UP, BP I had a significantly higher incidence of intradepressive hypomanic symptoms. Bipolar family history was found to be the strongest predictor of bipolarity in depression. CONCLUSIONS Overall, our findings confirm most of the classical signs of bipolarity in depression and support the view that some features, such as BPFH, together with some specific symptoms may help in detecting depressed subjects at higher risk for BP disorder.
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Affiliation(s)
- Daniel Souery
- Laboratoire de Psychologie Medicale, Université Libre de Bruxelles and Psy Pluriel, Centre Europeén de Psychologie Medicale, Brussels, Belgium
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General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA section of pharmacopsychiatry. Eur Arch Psychiatry Clin Neurosci 2011; 261 Suppl 3:207-45. [PMID: 22033583 DOI: 10.1007/s00406-011-0259-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Current gold standard approaches to the treatment of depression include pharmacotherapeutic and psychotherapeutic interventions with social support. Due to current controversies concerning the efficacy of antidepressants in randomized controlled trials, the generalizability of study findings to wider clinical practice and the increasing importance of socioeconomic considerations, it seems timely to address the uncertainty of concerned patients and relatives, and their treating psychiatrists and general practitioners. We therefore discuss both the efficacy and clinical effectiveness of antidepressants in the treatment of depressive disorders. We explain and clarify useful measures for assessing clinically meaningful antidepressant treatment effects and the types of studies that are useful for addressing uncertainties. This includes considerations of methodological issues in randomized controlled studies, meta-analyses, and effectiveness studies. Furthermore, we summarize the differential efficacy and effectiveness of antidepressants with distinct pharmacodynamic properties, and differences between studies using antidepressants and/or psychotherapy. We also address the differential effectiveness of antidepressant drugs with differing modes of action and in varying subtypes of depressive disorder. After highlighting the clinical usefulness of treatment algorithms and the divergent biological, psychological, and clinical efforts to predict the effectiveness of antidepressant treatments, we conclude that the spectrum of different antidepressant treatments has broadened over the last few decades. The efficacy and clinical effectiveness of antidepressants is statistically significant, clinically relevant, and proven repeatedly. Further optimization of treatment can be helped by clearly structured treatment algorithms and the implementation of psychotherapeutic interventions. Modern individualized antidepressant treatment is in most cases a well-tolerated and efficacious approach to minimize the negative impact of otherwise potentially devastating and life-threatening outcomes in depressive disorders.
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Saatcioglu O, Erim R, Tomruk N, Oral T, Alpay N. Antidepressant-associated mania or hypomania: a comparison with personality and bipolarity features of bipolar I disorder. J Affect Disord 2011; 134:85-90. [PMID: 21632117 DOI: 10.1016/j.jad.2011.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/10/2011] [Accepted: 05/10/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypomania/mania during antidepressant treatment is often neglected by clinicians. There are no specific diagnostic criteria for hypomania and mania associated by antidepressant treatment in the bipolar spectrum. The aim of this study is to compare various characteristics of bipolar I disorder and antidepressant-associated mania. METHOD In this study, 76 bipolar patients who met DSM-IV criteria for bipolar disorder-type I in remission from mania or depression (Group 1; n = 44) and patients with major depression in remission, who had mania associated by antidepressant treatment (Group 2; n = 32), were admitted. All patients were assessed using the SCID I, Bipolarity Index (BI) and a patient data form. First-degree relatives of all patients were evaluated using the Mood Disorder Questionnaire (MDQ). RESULTS Sociodemographic features of both groups were similar. The rate of major depression in the relatives of Group 2 was significantly higher than in Group 1. The severity of manic symptoms in Group 2 was significantly lower than in Group 1. Those in Group 2 who were diagnosed with their first episode had atypical depressive features. First-degree relatives of patients in Group 1 had higher positive scores on the MDQ. A statistically significant difference was found between the two groups on all dimensions of the BI except family history. LIMITATIONS This is a cross-sectional study with a relatively small number of subjects. There is no control group of major depressive patients who did not develop mania during antidepressive treatment. CONCLUSIONS Our results suggest that antidepressant-associated hypomania/mania could be a different subgroup in the bipolar spectrum.
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Affiliation(s)
- Omer Saatcioglu
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
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Gan Z, Diao F, Wei Q, Wu X, Cheng M, Guan N, Zhang M, Zhang J. A predictive model for diagnosing bipolar disorder based on the clinical characteristics of major depressive episodes in Chinese population. J Affect Disord 2011; 134:119-25. [PMID: 21684010 DOI: 10.1016/j.jad.2011.05.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/24/2011] [Accepted: 05/27/2011] [Indexed: 01/23/2023]
Abstract
BACKGROUND A correct timely diagnosis of bipolar depression remains a big challenge for clinicians. This study aimed to develop a clinical characteristic based model to predict the diagnosis of bipolar disorder among patients with current major depressive episodes. METHODS A prospective study was carried out on 344 patients with current major depressive episodes, with 268 completing 1-year follow-up. Data were collected through structured interviews. Univariate binary logistic regression was conducted to select potential predictive variables among 19 initial variables, and then multivariate binary logistic regression was performed to analyze the combination of risk factors and build a predictive model. Receiver operating characteristic (ROC) curve was plotted. RESULTS Of 19 initial variables, 13 variables were preliminarily selected, and then forward stepwise exercise produced a final model consisting of 6 variables: age at first onset, maximum duration of depressive episodes, somatalgia, hypersomnia, diurnal variation of mood, irritability. The correct prediction rate of this model was 78% (95%CI: 75%-86%) and the area under the ROC curve was 0.85 (95%CI: 0.80-0.90). The cut-off point for age at first onset was 28.5 years old, while the cut-off point for maximum duration of depressive episode was 7.5 months. LIMITATIONS The limitations of this study include small sample size, relatively short follow-up period and lack of treatment information. CONCLUSION Our predictive models based on six clinical characteristics of major depressive episodes prove to be robust and can help differentiate bipolar depression from unipolar depression.
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Affiliation(s)
- Zhaoyu Gan
- Department of Psychiatry, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
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Rothuber H, Mitterauer B. Comprehensive behavioral analysis of patients with a major depressive episode. Med Sci Monit 2011; 17:CR259-64. [PMID: 21525807 PMCID: PMC3539591 DOI: 10.12659/msm.881765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 01/20/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A major depressive episode diagnosed according to DSM-IV criteria can be accompanied by symptoms that DSM-IV does not include. These symptoms are sometimes classified as comorbidities. Our study assessed altered behavioral modes during a major depressive episode; ie, if 1 or more modes of behavior operated less or even not at all ("never"), or if the operation of others was more frequent or even constant ("always"). We hypothesize that these altered behavioral modes, especially the extreme positions "never" (hypomodes) and "always" (hypermodes) might correlate with depression scores and thus represent a typical symptom of depression. MATERIAL/METHODS We used the 35-item Salzburg Subjective Behavioral Analysis (SSBA) questionnaire to measure altered behavioral modes in 63 depressed patients and 87 non-depressed controls. Depression was assessed using the Hamilton Depression Scale. RESULTS In our test group (n=63) we found a total of 888 extreme positions. The mean number of extreme positions per patient was 11.15±5.173 (SD). Extreme positions were found in all 35 behavioral modes. The mean Hamilton score was 22.08±7.35 (SD). The association of the incidence of extreme positions and the Hamilton score in our test group was highly significant (Spearman's Rho=0.41; p=.001). In the control group (n=87), only 11 persons were found to display extreme positions, with a total of only 25. CONCLUSIONS Although this study has several limitations, such as the small sample or the use of a questionnaire in the validation procedure, the significant correlation of extreme positions and the Hamilton score indicate that altered modes of behavior as detected with the SSBA might be typical symptoms in a major depressive episode.
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Affiliation(s)
- Helfried Rothuber
- University Clinic for Psychiatry and Psychotherapy I, Christian Doppler Clinic, Salzburg, Austria.
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Perlis RH, Uher R, Ostacher M, Goldberg JF, Trivedi MH, Rush AJ, Fava M. Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder. ACTA ACUST UNITED AC 2010; 68:351-60. [PMID: 21135313 DOI: 10.1001/archgenpsychiatry.2010.179] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT It has been suggested that patients with major depressive disorder (MDD) who display pretreatment features suggestive of bipolar disorder or bipolar spectrum features might have poorer treatment outcomes. OBJECTIVE To assess the association between bipolar spectrum features and antidepressant treatment outcome in MDD. DESIGN Open treatment followed by sequential randomized controlled trials. SETTING Primary and specialty psychiatric outpatient centers in the United States. PARTICIPANTS Male and female outpatients aged 18 to 75 years with a DSM-IV diagnosis of nonpsychotic MDD who participated in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. INTERVENTIONS Open treatment with citalopram followed by up to 3 sequential next-step treatments. MAIN OUTCOME MEASURES Number of treatment levels required to reach protocol-defined remission, as well as failure to return for the postbaseline visit, loss to follow-up, and psychiatric adverse events. For this secondary analysis, putative bipolar spectrum features, including items on the mania and psychosis subscales of the Psychiatric Diagnosis Screening Questionnaire, were examined for association with treatment outcomes. RESULTS Of the 4041 subjects who entered the study, 1198 (30.0%) endorsed at least 1 item on the psychosis scale and 1524 (38.1%) described at least 1 recent maniclike/hypomaniclike symptom. Irritability and psychoticlike symptoms at entry were significantly associated with poorer outcomes across up to 4 treatment levels, as were shorter episodes and some neurovegetative symptoms of depression. However, other indicators of bipolar diathesis including recent maniclike symptoms and family history of bipolar disorder as well as summary measures of bipolar spectrum features were not associated with treatment resistance. CONCLUSION Self-reported psychoticlike symptoms were common in a community sample of outpatients with MDD and strongly associated with poorer outcomes. Overall, the data do not support the hypothesis that unrecognized bipolar spectrum illness contributes substantially to antidepressant treatment resistance.
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Affiliation(s)
- Roy H Perlis
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Fountoulakis KN. The emerging modern face of mood disorders: a didactic editorial with a detailed presentation of data and definitions. Ann Gen Psychiatry 2010; 9:14. [PMID: 20385020 PMCID: PMC2865463 DOI: 10.1186/1744-859x-9-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 04/12/2010] [Indexed: 12/17/2022] Open
Abstract
The present work represents a detailed description of our current understanding and knowledge of the epidemiology, etiopathogenesis and clinical manifestations of mood disorders, their comorbidity and overlap, and the effect of variables such as gender and age. This review article is largely based on the 'Mood disorders' chapter of the Wikibooks Textbook of Psychiatry http://en.wikibooks.org/wiki/Textbook_of_Psychiatry/Mood_Disorders.
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Fountoulakis KN, Gonda X, Vieta E, Schmidt F. Treatment of psychotic symptoms in bipolar disorder with aripiprazole monotherapy: a meta-analysis. Ann Gen Psychiatry 2009; 8:27. [PMID: 20043829 PMCID: PMC2812439 DOI: 10.1186/1744-859x-8-27] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 12/31/2009] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We present a systematic review and meta-analysis of the available clinical trials concerning the usefulness of aripiprazole in the treatment of the psychotic symptoms in bipolar disorder. METHODS A systematic MEDLINE and repository search concerning clinical trials for aripiprazole in bipolar disorder was conducted. RESULTS The meta-analysis of four randomised controlled trials (RCTs) on acute mania suggests that the effect size of aripiprazole versus placebo was equal to 0.14 but a more reliable and accurate estimation is 0.18 for the total Positive and Negative Syndrome Scale (PANSS) score. The effect was higher for the PANSS-positive subscale (0.28), PANSS-hostility subscale (0.24) and PANSS-cognitive subscale (0.20), and lower for the PANSS-negative subscale (0.12). No data on the depressive phase of bipolar illness exist, while there are some data in favour of aripiprazole concerning the maintenance phase, where at week 26 all except the total PANSS score showed a significant superiority of aripiprazole over placebo (d = 0.28 for positive, d = 0.38 for the cognitive and d = 0.71 for the hostility subscales) and at week 100 the results were similar (d = 0.42, 0.63 and 0.48, respectively). CONCLUSION The data analysed for the current study support the usefulness of aripiprazole against psychotic symptoms during the acute manic and maintenance phases of bipolar illness.
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Lee S, Ng KL, Tsang A. Prevalence and correlates of depression with atypical symptoms in Hong Kong. Aust N Z J Psychiatry 2009; 43:1147-54. [PMID: 20001414 DOI: 10.3109/00048670903279895] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Previous studies of atypical depression have been conducted in Western communities. There has been no community-based epidemiological study of atypical depression that covers the entire spectrum of bipolar disorders. The aim of the present study was to examine the 12 month prevalence of atypical depression and the differences in demographic and clinical profiles between depressed patients with and without atypical symptoms in the Chinese adult population of Hong Kong. METHOD A random sample of 3016 Chinese adults completed a telephone-based structured interview that examined their 12 month prevalence of major depressive episode. Atypical depression was defined as major depressive episode with hypersomnia and increased weight or appetite. Major depressive episode with and without atypical symptoms were compared on sociodemographic variables, number of depressive and manic/hypomanic symptoms, proportion of having lifetime mania/hypomania, suicidality, family psychiatric history, help-seeking behaviour, level of distress and role impairment. RESULTS The 12 month prevalence of atypical depression was 1.3%. Compared to non-atypical depression, atypical depression was associated with female gender, soft (subthreshold) bipolar II disorder, family psychiatric history, higher suicidality, more help-seeking from psychiatrists, and more depressive and manic/hypomanic symptoms. There was no difference in levels of distress or impairment. CONCLUSIONS Although limited by the lack of detailed information on comorbidity, bipolar family history, and age of onset, the findings support the hypothesis that atypical depression among Chinese people in Hong Kong exhibited prevalence and correlates similar to those found in Western epidemiological and clinical studies. Further research is warranted to examine its association with hypomania and how atypical depression may occupy a nosological position between typical unipolar depression and bipolar spectrum disorders.
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Affiliation(s)
- Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Vigo DV, Baldessarini RJ. Anticonvulsants in the treatment of major depressive disorder: an overview. Harv Rev Psychiatry 2009; 17:231-41. [PMID: 19637072 DOI: 10.1080/10673220903129814] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Major depressive disorder (MDD) is highly prevalent, potentially disabling, and sometimes fatal. Antidepressants (ADs) have improved its treatment, but incomplete response, sustained morbidity, recurrences, agitation, substance abuse, excess medical mortality, and suicide remain unsolved problems among mood disorder patients. AD treatment itself sometimes induces adverse behavioral responses. Several anticonvulsants (ACs) used to treat bipolar disorder (BPD) might also be of value for MDD. Accordingly, we reviewed published reports on ACs for MDD, identifying studies by computerized searches. We excluded reports dealing only with BPD patients or with sedatives, classified trials by design quality, and evaluated treatment of acute episodes and recurrences of adult MDD. We found 36 reports involving 41 relevant trials of carbamazepine (12 trials), valproate (11), lamotrigine (9), gabapentin (3), topiramate (3), phenytoin (2), and tiagabine (1). They include 9 blinded, controlled trials (of 28-70 days), involving carbamazepine (3 trials), lamotrigine (3), phenytoin (2), or topiramate (1) as primary treatments (5) or AD adjuncts (4). Some of these trials, as well as 7 of lesser quality, suggest benefits of carbamazepine, lamotrigine, and valproate, mainly as adjuncts to ADs. Another 20 anecdotes or small trials further suggest that these ACs might be useful as AD adjuncts-specifically to treat irritability or agitation in MDD. Overall, these reports provide suggestive evidence of beneficial effects of carbamazepine, lamotrigine, and valproate that require further study, especially for long-term adjunctive use, particularly in patients with recurring MDD with prominent irritability or agitation.
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Affiliation(s)
- Daniel V Vigo
- Department of Psychiatry, Harvard Medical School, MA, USA.
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Sánchez-Gistau V, Colom F, Mané A, Romero S, Sugranyes G, Vieta E. Atypical depression is associated with suicide attempt in bipolar disorder. Acta Psychiatr Scand 2009; 120:30-6. [PMID: 19183125 DOI: 10.1111/j.1600-0447.2008.01341.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is a dearth of research focusing on factors associated with suicide attempts. High rates of atypical depression have been reported in studies including unipolar and bipolar II patients. In this study, the association between suicide attempt and atypical depression, in addition to other major risk factors, was evaluated in 390 bipolar I and II out-patients. METHOD Variables were defined according to DSM-IV criteria, and assessed with a Structured Interview for DSM-IV (axis I and II). History of suicide attempt was obtained through interviews with patients and relatives. Attempters and non-attempters were compared using univariate and multivariate analysis. RESULTS Attempters showed significantly higher rates of atypical depression, family history of completed suicide, depression at index episode and cluster B personality disorder. CONCLUSION Our results highlight the relevance of atypical depression in bipolar disorder. A more accurate identification of potential attempters may contribute to the development of effective preventive treatment strategies.
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Affiliation(s)
- V Sánchez-Gistau
- Bipolar Disorders Program, Institute of Clinical Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Catalonia, Spain
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Abstract
Manic depression, or bipolar disorder, is a multifaceted illness with an inevitably complex treatment. The current article summarizes the current status of our knowledge and practice concerning its diagnosis and treatment. While the prototypic clinical picture concerns the "classic" bipolar disorder, today mixed episodes with incomplete recovery and significant psychosocial impairment are more frequent. The clinical picture of these mixed episodes is variable, eludes contemporary classification systems, and possibly includes a constellation of mental syndromes currently classified elsewhere. Treatment includes the careful combination of lithium, antiepileptics, atypical antipsychotics, and antidepressants, but not all of the agents in these broad categories are effective for the treatment of bipolar disorder.
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