Mixed Hypomania in 908 Patients With Bipolar Disorder Evaluated Prospectively in the Stanley Foundation Bipolar Treatment Network

Suppes, Trisha; Mintz, Jim; McElroy, Susan L.; Altshuler, Lori L.; Kupka, Ralph; Frye, Mark A.; Keck, Paul E.; Nolen, Willem A.; Leverich, Gabriele S.; Grunze, Heinz; Rush, A. John; Post, Robert M.

doi:10.1001/archpsyc.62.10.1089

Cited by 183 publications

(133 citation statements)

References 42 publications

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“…This does not mean that these symptoms are always bipolar, only that a bipolar nature is more likely than not in mood disorders (a bipolar nature of irritability and psychomotor agitation in psychotic disorders is expected to be unlikely). The bipolar nature of mixed depression (of which irritability, psychomotor agitation, and distractibility are among the most frequent symptoms) was supported by BP family history (odds ratio = 3.3; controlling for BP-II = 2.4) by a dose-response relationship between the number of intradepression hypomanic symptoms and BP family history loading [38, 47, 48, 61], by finding factors of mania/hypomania in mixed depression [37, 55, 56,71,72,73], and by finding MDE in hypomania [53, 60, 62]. While depression is common in many axis I and axis II disorders, mania and hypomania are more specific of BP [3, 74, 75].…”

Section: Resultsmentioning

confidence: 99%

“…There are descriptions of mixed depression in Falret’s ‘circular insanity’ [39], Hecker’s ‘cyclothymia’ [40], and in Kraepelin’s ‘manic-depressive insanity’ [3]. Mixed depression has recently been described in BP-I, BP-II, and MDD [35, 38,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Frequency of mixed depression, defined as an MDE plus at least 2 or 3 noneuphoric manic/hypomanic symptoms, was up to 70% in BP, and up to 30% in MDD.…”

Section: Resultsmentioning

confidence: 99%

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Is There a Continuity between Bipolar and Depressive Disorders?

Benazzi¹

2007

Psychother Psychosom

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Background: Recent studies questioned the current categorical split of mood disorders into bipolar disorders (BP) and depressive disorders (MDD). Methods: Medline database search of papers from the last 10 years on the categorical-dimensional classification of mood disorders. Various combinations of the following key words were used: mood disorders, bipolar, unipolar, major depressive disorder, spectrum, category/categorical, classification, continuity. Only English language clinical papers were included, review papers were excluded, similar papers selected by quality. The number of papers found was 1,141. The number of papers selected was 109. Results: The continuity/spectrum between BP (mainly BP-II) and MDD was supported by the following findings:(1) high frequency of mixed states (mixed mania, mixed hypomania, mixed depression, i.e. co-occurring depression and noneuphoric manic/hypomanic symptoms) because opposite polarity symptoms in the same episode do not support a hypomania/mania-depression splitting; (2) MDD was the most common mood disorder in BP probands’ relatives; (3) no bimodal distribution of distinguishing symptoms between BP and MDD; (4) bipolar signs not uncommon in MDD; (5) many MDD shifting to BP; (6) many lifetime manic/hypomanic symptoms in MDD; (7) correlation between lifetime manic/hypomanic symptoms and MDD symptoms; (8) hypomania factors in MDD; (9) MDD often recurrent; (10) similar cognitive style.The categorical distinction between BP (mainly BP-I) and MDD was supported by the following findings: (1) BP more common in BP probands’ relatives; (2) lower age at BP onset; (3) females as common as males in BP-I, more common than males in MDD; (4) BP-I depression more atypical and retarded, MDD depression more sleepless and agitated; (5) BP more recurrent. Conclusions: Focusing on mood spectrum’s extremes (BP-I vs. MDD), a categorical distinction seems supported. Focusing on midway disorders (BP-II and MDD plus bipolar signs), a continuity/spectrum seems supported. Results seem to support both a categorical and a dimensional view of mood disorders.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Is There a Continuity between Bipolar and Depressive Disorders?

Benazzi¹

2007

Psychother Psychosom

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“…While most studies agree that MxD has worse outcomes than non-MxD and is less responsive to, or even worsened by, common antidepressant treatments [24,25,26,27,28,29,30,31], one recent large study found that the likelihood of remission was greater in depressive patients with DSM-5 mixed features treated with antidepressants [32]. However, data on this topic are limited [7,33,34,35,36].…”

Section: Introductionmentioning

confidence: 99%

Mixed Depression: Clinical Features and Predictors of Its Onset Associated with Antidepressant Use

Sani¹,

Napoletano

Vöhringer

et al. 2014

Psychother Psychosom

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Background: Mixed depression (MxD) is narrowly defined in the DSM-IV and somewhat broader in the DSM-5, although both exclude psychomotor agitation as a diagnostic criterion. This article proposes a clinical description for defining MxD, which emphasizes psychomotor excitation. Methods: Two hundred and nineteen consecutive outpatients were diagnosed with an MxD episode using criteria proposed by Koukopoulos et al. [Acta Psychiatr Scand 2007;115(suppl 433):50-57]; we here report their clinical features and antidepressant-related effects. Results: The most frequent MxD symptoms were: psychic agitation or inner tension (97%), absence of retardation (82%), dramatic description of suffering or weeping spells (53%), talkativeness (49%), and racing or crowded thoughts (48%). MxD was associated with antidepressants in 50.7% of patients, with similar frequency for tricyclic antidepressants (45%) versus selective serotonin reuptake inhibitors (38.5%). Positive predictors of antidepressant-associated MxD were bipolar disorder type II diagnosis, higher index depression severity, and higher age at index episode. Antipsychotic or no treatment was protective against antidepressant-associated MxD. Conclusions: MxD, defined as depression with excitatory symptoms, can be clinically identified, is common, occurs in both unipolar depression and bipolar disorder, and is frequently associated with antidepressant use. If replicated, this view of MxD could be considered a valid alternative to the DSM-5 criteria for depression with mixed features.

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“…Significantly, a recent large systematic investigation of the nature of hypomania suggests that hypomania is often mixed with depressed mood, especially in women. 27 This quality of hypomania tends to be expressed as activated or agitated depression and may further hinder bipolar recognition.…”

Section: Dsm-ivmentioning

confidence: 99%