Depressive mania versus agitated depression: Biogenic amine and hypothalamic-pituitary-adrenocortical function

Alan C. Swann, Peter E. Stokes, Steven K. Secunda, James W. Maas, Charles L. Bowden, Nancy Berman, Stephen H. Koslow

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


The existence of mixed affective states challenges the idea of specific biological abnormalities in depression and mania. We compared biogenic amines and hypothalamic-pituitary-adrenocortical (HPA) function in mixed manic (n = 8), pure manic (n = 11), agitated bipolar depressed (n = 20), and nonaagitated bipolar depressed (n = 27) inpatients (Research Diagnostic Criteria). Mixed manics met Research Diagnostic Criteria for primary manic episodes and also met criteria for major depressive episodes except for duration. The norepinephrine metabolite methoxyhydroxy phenthylene glycol (MHPG) was higher in cerebrospinal fluid from mixed manic than from agitated depressed patients, consistent with differences previously reported between the overall samples of depressed and manic patients. Similarly, patients in a mixed state had higher urinary excretion of norepinephrine (NE) and elevated output of NE relative to its metabolites. HPA activity was similar in mixed manic and agitated depressed patients. These data suggest that mixed manics combine certain biological abnormalities considered to be characteristic of mania and of depression.

Original languageEnglish (US)
Pages (from-to)803-813
Number of pages11
JournalBiological Psychiatry
Issue number10
StatePublished - May 15 1994


  • Bipolar disorder
  • catecholamines
  • cortisol
  • depression
  • mania
  • mixed states
  • norepinephrine

ASJC Scopus subject areas

  • Biological Psychiatry


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