Abstract
Objective: Little is known about how often bipolar depressive episodes are accompanied by subsyndromal manic symptoms in bipolar I and II disorders. The authors sought to determine the frequency and clinical correlates of manic symptoms during episodes of bipolar depression. Method: From among 4,107 enrollees in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), 1,380 individuals met criteria for bipolar I or II depressive syndromes at the time of enrollment and were assessed for concomitant manic symptoms. Illness characteristics were compared in patients with pure bipolar depressed episodes and those with mixed depressive presentations. Results: Two-thirds of the subjects with bipolar depressed episodes had concomitant manic symptoms, most often distractibility, flight of ideas or racing thoughts, and psychomotor agitation. Patients with any mixed features were significantly more likely than those with pure bipolar depressed episodes to have early age at illness onset, rapid cycling in the past year, bipolar I subtype, history of suicide attempts, and more days in the preceding year with irritability or mood elevation. Conclusions: Manic symptoms often accompany bipolar depressive episodes but may easily be overlooked when they appear less prominent than depressive features. Subsyndromal manic symptoms during bipolar I or II depression demarcate a more common, severe, and psychopathologically complex clinical state than pure bipolar depression and merit recognition as a distinct nosologic entity.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 173-181 |
| Number of pages | 9 |
| Journal | American Journal of Psychiatry |
| Volume | 166 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2009 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Psychiatry and Mental health
Cite this
Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder : Findings from the STEP-BD. / Goldberg, Joseph F.; Perlis, Roy H.; Bowden, Charles L.; Thase, Michael E.; Miklowitz, David J.; Marangell, Lauren B.; Calabrese, Joseph R.; Nierenberg, Andrew A.; Sachs, Gary S.
In: American Journal of Psychiatry, Vol. 166, No. 2, 02.2009, p. 173-181.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder
T2 - Findings from the STEP-BD
AU - Goldberg, Joseph F.
AU - Perlis, Roy H.
AU - Bowden, Charles L.
AU - Thase, Michael E.
AU - Miklowitz, David J.
AU - Marangell, Lauren B.
AU - Calabrese, Joseph R.
AU - Nierenberg, Andrew A.
AU - Sachs, Gary S.
PY - 2009/2
Y1 - 2009/2
N2 - Objective: Little is known about how often bipolar depressive episodes are accompanied by subsyndromal manic symptoms in bipolar I and II disorders. The authors sought to determine the frequency and clinical correlates of manic symptoms during episodes of bipolar depression. Method: From among 4,107 enrollees in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), 1,380 individuals met criteria for bipolar I or II depressive syndromes at the time of enrollment and were assessed for concomitant manic symptoms. Illness characteristics were compared in patients with pure bipolar depressed episodes and those with mixed depressive presentations. Results: Two-thirds of the subjects with bipolar depressed episodes had concomitant manic symptoms, most often distractibility, flight of ideas or racing thoughts, and psychomotor agitation. Patients with any mixed features were significantly more likely than those with pure bipolar depressed episodes to have early age at illness onset, rapid cycling in the past year, bipolar I subtype, history of suicide attempts, and more days in the preceding year with irritability or mood elevation. Conclusions: Manic symptoms often accompany bipolar depressive episodes but may easily be overlooked when they appear less prominent than depressive features. Subsyndromal manic symptoms during bipolar I or II depression demarcate a more common, severe, and psychopathologically complex clinical state than pure bipolar depression and merit recognition as a distinct nosologic entity.
AB - Objective: Little is known about how often bipolar depressive episodes are accompanied by subsyndromal manic symptoms in bipolar I and II disorders. The authors sought to determine the frequency and clinical correlates of manic symptoms during episodes of bipolar depression. Method: From among 4,107 enrollees in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), 1,380 individuals met criteria for bipolar I or II depressive syndromes at the time of enrollment and were assessed for concomitant manic symptoms. Illness characteristics were compared in patients with pure bipolar depressed episodes and those with mixed depressive presentations. Results: Two-thirds of the subjects with bipolar depressed episodes had concomitant manic symptoms, most often distractibility, flight of ideas or racing thoughts, and psychomotor agitation. Patients with any mixed features were significantly more likely than those with pure bipolar depressed episodes to have early age at illness onset, rapid cycling in the past year, bipolar I subtype, history of suicide attempts, and more days in the preceding year with irritability or mood elevation. Conclusions: Manic symptoms often accompany bipolar depressive episodes but may easily be overlooked when they appear less prominent than depressive features. Subsyndromal manic symptoms during bipolar I or II depression demarcate a more common, severe, and psychopathologically complex clinical state than pure bipolar depression and merit recognition as a distinct nosologic entity.
UR - http://www.scopus.com/inward/record.url?scp=60349113309&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=60349113309&partnerID=8YFLogxK
U2 - 10.1176/appi.ajp.2008.08050746
DO - 10.1176/appi.ajp.2008.08050746
M3 - Article
C2 - 19122008
AN - SCOPUS:60349113309
VL - 166
SP - 173
EP - 181
JO - American Journal of Psychiatry
JF - American Journal of Psychiatry
SN - 0002-953X
IS - 2
ER -