Atypical features in depression: Association with obesity and bipolar disorder

Łojko, Dorota; Buzuk, Grzegorz; Owecki, Maciej; Ruchała, Marek; Rybakowski, Janusz

doi:10.1016/j.jad.2015.06.020

Cited by 46 publications

(25 citation statements)

References 40 publications

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“…Usually greater in women (Carpenter et al, 2000;de Wit et al, 2010;Heo et al, 2006;Mitchell et al, 2012), depressive symptoms that develop in obese individuals often present atypical features such as increased appetite/weight gain, mood reactivity, and hypersomnia/fatigue (Chou and Yu, 2013;Levitan et al, 2012;Lojko et al, 2015). In agreement with this, overweight, obesity, and metabolic abnormalities, including leptin deregulation, appear to be more prevalent in atypical depression than in melancholic/typical depression (Chou and Yu, 2013;Cizza et al, 2012;Lamers et al, 2010;Lasserre et al, 2014;Levitan et al, 2012;Milaneschi et al, 2015).…”

Section: Fat and Depression: A Vicious Circlementioning

confidence: 95%

Role of Adiposity-Driven Inflammation in Depressive Morbidity

Capuron

Lasselin

Castanon

2016

Neuropsychopharmacol

141

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Depression and metabolic disorders, including overweight and obesity, appear tightly interrelated. The prevalence of these conditions is concurrently growing worldwide, and both depression and overweight/obesity represent substantial risk factors for multiple medical complications. Moreover, there is now multiple evidence for a bidirectional relationship between depression and increased adiposity, with overweight/obesity being associated with an increased prevalence of depression, and in turn, depression augmenting the risk of weight gain and obesity. Although the reasons for this intricate link between depression and increased adiposity remain unclear, converging clinical and preclinical evidence points to a critical role for inflammatory processes and related alterations of brain functions. In support of this notion, increased adiposity leads to a chronic low-grade activation of inflammatory processes, which have been shown elsewhere to have a potent role in the pathophysiology of depression. It is therefore highly possible that adiposity-driven inflammation contributes to the development of depressive disorders and their growing prevalence worldwide. This review will present recent evidence in support of this hypothesis and will discuss the underlying mechanisms and potential therapeutic targets. Altogether, findings presented here should help to better understand the mechanisms linking adiposity to depression and facilitate the identification of new preventive and/or therapeutic strategies.

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Section: Fat and Depression: A Vicious Circlementioning

confidence: 95%

Role of Adiposity-Driven Inflammation in Depressive Morbidity

Capuron

Lasselin

Castanon

2016

Neuropsychopharmacol

141

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“…Particularly, those patients with early onset and a high number of episodes in early life are at risk to convert to bipolar disorder. (Akiskal et al 1989, 2000; Angst et al 2013; Lojko et al 2015; Rihmer et al 2016; Park and Lee 2016). …”

Section: The Course Of Unipolar Depressionmentioning

confidence: 99%

Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression

Abou‐Saleh

Müller‐Oerlinghausen

Coppen³

2017

Int J Bipolar Disord

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BackgroundDepressive disorders are a leading cause of the global burden of disease and are associated with high recurrent often continuing morbidity and high excess mortality by suicide and cardiovascular disease. Whilst there are established, effective and cost-effective treatments for depression, their long-term management is often neglected: there is continuing controversy over the case of need for long-term treatment including lifelong treatment and safety issues.Objective and methodsIn this narrative review, we critically examine the evidence for the effectiveness and safety of lithium salts in the long-term management of unipolar depression. We refer to existing recent international guidelines as well as the scientific literature selectively and against the background of our longstanding experience with patients suffering from unipolar depression who are often under treated or inappropriately treated.Results and discussionAccording to many studies mostly dating back to the 1970/1980s, lithium is efficacious in the prophylaxis of unipolar depression particularly depression with melancholia and delusional depression and showing a clearly episodic course. Also the efficacy of lithium maintenance treatment following recovery by ECT has been clearly shown. Moreover, convincing evidence exists that lithium has added value and benefit for its unique anti-suicidal effects as well as reducing mortality by other causes. The anti-suicidal effect has been convincingly demonstrated in bipolar as well as in unipolar patients. Nevertheless its use in the management of patients with unipolar depression has not been properly recognized by a majority of textbooks and guidelines. Whilst it has been well considered as an effective treatment for depression that has not responded to antidepressants as an adjunct treatment, also called augmentation, it has been much less recommended for the prevention of recurrent episodes of unipolar depression. One of the reasons for this neglect is the blurring of the diagnosis “unipolar depression” by modern diagnostic tools. Lithium will hardly work in a patient with “unipolar depression spectrum disease”.ConclusionsWe conclude that lithium is an effective prophylactic treatment for carefully selected patients with unipolar depression and is safe when prescribed in recommended doses/plasma lithium levels and with regular, careful monitoring. We propose that lithium prophylaxis can be indicated in patients with unipolar depression and that the occurrence of 2 episodes of depression within 5 years is a practical criterion for starting lithium prophylaxis particularly in severe depression with psychotic features and high suicidal risk. Furthermore, an indication might be considered especially in unipolar patients in whom a bipolar background is suspected. In some cases, lithium prophylaxis may be recommended after a single episode of depression that is severe with high suicidal risk and continued life-long.

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“…A relationship between depression, especially with atypical features, and obesity has been widely demonstrated . Moreover, atypical symptoms in depressed patients have been associated with both obesity and BD . Notably, obese (OB) patients have been shown to have a higher risk of developing MDD and BD .…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta‐analysis of nine cross‐sectional epidemiological studies confirmed that obesity is associated with an increased prevalence of BD; however, the mechanisms and temporal sequence underlying this relationship are poorly understood . Regarding gender differences, women showed higher rates of atypical features, as well as a higher body mass index (BMI) than males, especially abdominal obesity . Furthermore, the rate of obesity in women with BD has been found to be higher than in men with BD .…”

Section: Introductionmentioning

confidence: 99%

Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

et al. 2017

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Objectives: BRIDGE-II-MIX study aimed to estimate the frequency of mixed states in patients with MDE according to different definitions. This post-hoc analysis evaluates the association between obesity and the presence of mixed features and bipolarity. Methods: 2811 MDE subjects were enrolled in this multicentre crosssectional study. In 2744 patients, the body mass index (BMI) has been evaluated.Psychiatric symptoms, socio-demographic and clinical variables were collected, comparing the characteristics of MDE patients with (MDE-OB) and without obesity (MDE-NOB). Results: obesity (BMI ≥30) was registered in 493 patients (18%). In the MDE-OB group, 90 patients (20%) fulfilled DSM-IV-TR criteria for BD, 225 patients (50%) fulfilled the criteria for bipolarity specifier, 59 patients (13%) fulfilled DSM-5 criteria for MDE with mixed features and 226 patients (50%) fulfilled Research-Based Diagnostic Criteria for a mixed depressive episode. Older age, history of (hypo)manic switches during antidepressant treatment, the occurrence of three or more MDEs, atypical depressive features, antipsychotic treatment, female gender, depressive mixed state according to DSM-5 criteria, comorbid eating disorders and anxiety disorders were significantly associated with MDE-OB group. Among (hypo)manic symptoms during the current MDE, psychomotor agitation, distractibility, increased energy and risky behaviors were the variables most frequently associated with MDE-OB group.Conclusions: In our sample, the presence of obesity in patients with MDE seems to be associated with a lifetime diagnosis of BD. These findings suggest that obesity in patients with MDE could be considered a possible marker of bipolarity.

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Atypical features in depression: Association with obesity and bipolar disorder

Cited by 46 publications

References 40 publications

Role of Adiposity-Driven Inflammation in Depressive Morbidity

Role of Adiposity-Driven Inflammation in Depressive Morbidity

Lithium in the episode and suicide prophylaxis and in augmenting strategies in patients with unipolar depression

Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

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