Agitated “unipolar” depression re-conceptualized as a depressive mixed state: implications for the antidepressant-suicide controversy

Akiskal, Hagop S.; Benazzi, Franco; Perugi, Giulio; Rihmer, Zoltán

doi:10.1016/j.jad.2004.12.004

Cited by 303 publications

(207 citation statements)

References 90 publications

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“…Our findings extend research which has found that bipolar adults with high levels of anxiety are more likely to exhibit suicidal behavior (Young et al, 1993). They also support the findings of Akiskal et al (2005) that among adults with unipolar major depressive disorder, psycho-motor activation and racing thoughts independently predict suicidal ideation. Thus, mood episodes characterized by mixed symptoms may be a risk factor for suicidality among adults and adolescents.…”

Section: Discussionsupporting

confidence: 85%

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder

Biuckians

Miklowitz

Kim

2007

Journal of Affective Disorders

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Background-Hypomania/mania and depression are hypothesized to correspond to high and low expressions of behavioral activation system (BAS) activity, respectively, in bipolar individuals. In contrast, behavioral inhibition system (BIS) activity is hypothesized to regulate anxiety. The aim of the present study was to examine whether self-reported levels of BAS functioning in bipolar adolescents corresponded with levels of concurrent manic and depressive symptomatology. The secondary aim was to investigate whether self-reported BIS levels were associated with self-reported anxiety symptoms.

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Section: Discussionsupporting

confidence: 85%

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder

Biuckians

Miklowitz

Kim

2007

Journal of Affective Disorders

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“…Recently, these findings have been extended to similar relationships in children and adolescents with MDD (Peluso et al, 2007). Akiskal et al (2005) have suggested that approximately 20% of depressed patients may present with an agitated unipolar depression that shares some features of a depressive mixed state with distractibility, racing thoughts, an irritable mood, talkativeness, risky behavior, and increased suicidality. Impulsivity appears to discriminate depressed subjects without a history of suicide attempts from those with a positive personal history (Perroud et al, 2011).…”

Section: Introductionmentioning

confidence: 78%

The Utility of Impulsive Bias and Altered Decision Making as Predictors of Drug Efficacy and Target Selection: Rethinking Behavioral Screening for Antidepressant Drugs

Marek

Day

Hudzik

2015

Journal of Pharmacology and Experimental Therapeutics

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Cognitive dysfunction may be a core feature of major depressive disorder, including affective processing bias, abnormal response to negative feedback, changes in decision making, and increased impulsivity. Accordingly, a translational medicine paradigm predicts clinical action of novel antidepressants by examining drug-induced changes in affective processing bias. With some exceptions, these concepts have not been systematically applied to preclinical models to test new chemical entities. The purpose of this review is to examine whether an empirically derived behavioral screen for antidepressant drugs may screen for compounds, at least in part, by modulating an impulsive biasing of responding and altered decision making. The differential-reinforcement-of-low-rate (DRL) 72-second schedule is an operant schedule with a documented fidelity for discriminating antidepressant drugs from nonantidepressant drugs. However, a theoretical basis for this empirical relationship has been lacking. Therefore, this review will discuss whether response bias toward impulsive behavior may be a critical screening characteristic of DRL behavior requiring long interresponse times to obtain rewards. This review will compare and contrast DRL behavior with the five-choice serial reaction time task, a test specifically designed for assessing motoric impulsivity, with respect to psychopharmacological testing and the neural basis of distributed macrocircuits underlying these tasks. This comparison suggests that the existing empirical basis for the DRL 72-second schedule as a pharmacological screen for antidepressant drugs is complemented by a novel hypothesis that altering impulsive response bias for rodents trained on this operant schedule is a previously unrecognized theoretical cornerstone for this screening paradigm.

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“…Within mood disorders, there is a clinical state known in the literature as 'agitated' or 'excited' depression. These patients are classified as depressed in that their affective tone is negative, but their symptoms can include locomotor acceleration rather than locomotor retardation, restlessness rather than fatigue, a feeling of thoughts racing, and a desire to follow risky pleasurable impulses (Akiskal and Benazzi, 2004;Akiskal et al, 2005). Agitated depression is more common in patients who also have manic episodes, which leads to the A c c e p t e d m a n u s c r i p t 11 further question of whether mania could be related to the predictions of the model.…”

Section: Discussionmentioning

confidence: 99%

An evolutionary model of low mood states

Nettle

2009

Journal of Theoretical Biology

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A c c e p t e d m a n u s c r i p t 2 AbstractIt has been suggested that low mood in humans is an adaptive response to unpropitious circumstances, and that the anhedonia, pessimism and fatigue that often accompany it function to minimise risk until circumstances improve. While this is plausible, it would be possible to make the opposite prediction equally plausibly: individuals in bad circumstances should take greater risks in order to improve their situations. Here, I present a simple analytical model adapted from the risk-sensitive foraging literature. It shows that in dire states, individuals should be risk-prone, in poor states, risk-averse, and in good states, risk-prone again. I discuss how the various kinds of mood state observed in humans might be understood as mechanisms for adaptively adjusting behavioural risk-taking to the current situation.

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Agitated “unipolar” depression re-conceptualized as a depressive mixed state: implications for the antidepressant-suicide controversy

Cited by 303 publications

References 90 publications

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder

Behavioral activation, inhibition and mood symptoms in early-onset bipolar disorder

The Utility of Impulsive Bias and Altered Decision Making as Predictors of Drug Efficacy and Target Selection: Rethinking Behavioral Screening for Antidepressant Drugs

An evolutionary model of low mood states

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