The implications of hypersomnia in the context of major depression: Results from a large, international, observational study

Abstract

According to the DSM-5, "reduction in the need for sleep" is the only sleep-related criteria for mixed features in depressive episodes. We aimed at studying the prevalence, clinical correlates and the role of hypersomnia in a sample of acutely depressed patients. Secondarily, we factors significantly increasing the odds of hypersomnia were studied. We conducted a posthoc analysis of the BRIDGE-II-Mix study. Variables were compared between patients with hypersomnia (SLEEP +) and with insomnia (SLEEP −) with standard bivariate tests. A stepwise backward logistic regression model was performed with SLEEP + as dependent variable. A total of 2514 subjects were dichotomized into SLEEP + (n = 423, 16.8%) and SLEEP − (n = 2091, 83.2%). SLEEP + had significant higher rates of obese BMI (p < 0.001), BD diagnosis (p = 0.027), severe BD (p < 0.001), lifetime suicide attempts (p < 0.001), lower age at first depression (p = 0.004) than SLEEP −. Also, SLEEP + had significantly poorer response to antidepressants (AD) such as (hypo)manic switches, AD resistance, affective lability, or irritability (all 0 < 0.005). Moreover, SLEEP + had significantly higher rates of mixed-state specifiers than SLEEP-(all 0 < 0.006). A significant contribution to hypersomnia in our regression model was driven by metabolic-related features, such as "current bulimia" (OR = 4.21) and "overweight/obese BMI (OR = 1.42)". Globally, hypersomnia is associated with poor outcome in acute depression. Hypersomnia is strongly associated with mixed features and bipolarity. Metabolic aspects could influence the expression of hypersomnia, worsening the overall clinical outcome. Along with commonly used screening tools, detection of hypersomnia has potential, costless discriminative validity in the differential diagnosis unipolar and bipolar depression.

Characterization of rapid cycling bipolar patients presenting with major depressive episode within the BRIDGE‐II‐MIX study

“…Main strengths of this study include the large sample size of this multicentric international study, as well as its naturalistic design. In fact, this study provides useful information regarding the “real word” patients suffering from depression, and provides better understanding of patients with different clinical profiles, including those with predominant psychomotor symptoms, 75 excitatory symptoms, 76 hipersomnia,, 77 mood reactivity, 78 comorbidities, 79 highly recurrent course, 80 impaired functioning, 81 poor response to antidepressants, 82 and, in this case, RC, a particularly challenging condition. In addition, the assessment of specific recall variables, combined with the evaluation of current clinical features, contributes to detect important psychopathological differences between BD‐RC and BD‐NRC groups in patients with MDE.…”

Deconstructing major depressive episodes across unipolar and bipolar depression by severity and duration: a cross-diagnostic cluster analysis on a large, international, observational study

“…The BDs: Improving Diagnosis, Guidance and Education-mixed features (BRIDGE-II-MIX) study was a large, multinational, cross-sectional study, which enrolled 2811 adults aged 18 years and older with MDE according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-4-TR) diagnostic criteria at the time of the consultation and applied a descriptive, bottom-up approach with the primary aim of detecting mixed symptoms among such patients 21 . Several subanalyses have investigated the effects of comorbidity [22][23][24] , recurrence 25,26 , specific symptoms [27][28][29][30][31] , and treatment response 32,33 in patients with MDE from this data set, but none looked into the impact of severity and duration.…”

Physical health in affective disorders: a narrative review of the literature

“…Furthermore, sleep disturbances -common in BD and MDD -also increase the risk of obesity due to: 1) behavioral causes (insomnia increases the risk of nocturnal binges); 2) neurobiological reasons -decreasing leptin levels (leading to decreased satiety),which leads to increased ghrelin levels (also known as the hunger hormone) or decreased adiponectin (a hormone related to glycidic and lipid homeostasis); and 3) induction of inflammatory cytokines. 33,36,37 In fact, obesity, BD, and MDD have been considered by some authors to share a state of low-grade chronic inflammation. 12,32,33 A mismatch in neurotransmission systems may also be implicated in the bidirectional association between obesity and affective disorders, since obesity can be a consequence of binge eating disorder, in which dopaminergic dysregulation is implicated.…”

“…Thus, it is not associated with psychotropic drugs alone. 44 Finally, some of the clinical features of BD include hyperphagia, hypersomnia, and reduced physical activity, 37 which may lead to MetS, especially in depressive episodes. [56][57][58] Major depressive disorder MetS is present in approximately 30.5% of patients with MDD.…”

“…62 From a clinical point of view, certain MDD subtypes and symptom profiles, such as atypical depression, are more closely associated with MetS. 6 One explanation for this association could be that atypical depression usually presents with hyperphagia and hypersomnia, 37 as well as with significantly higher levels of inflammatory markers, body mass index, waist circumference, triglycerides, and lower HDL cholesterol than melancholic depression. 44 MetS can also contribute to a more complex presentation and worse clinical outcomes in MDD by leading to a worse course of illness, including more depressive episodes and suicide attempts and less responsiveness to treatment.…”