Prevalence of bipolar II disorder in atypical depression

The diagnostic validity of atypical depression is based on its superior response to monoamine oxidase inhibitors compared to tricyclic antidepressants, and on latent class analysis. The studies on atypical depression have often not included bipolar patients. The aim of the present study was to find the prevalence of bipolar II disorder among DSM-IV atypical depression outpatients. Bipolar II and unipolar atypical depressions were also compared to find if they were variants of the same disorder or if instead they were different disorders. One hundred and forty consecutive unipolar and bipolar II outpatients, presenting for treatment of an atypical major depressive episode, were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale (MADRS), and the Global Assessment of Functioning Scale. The prevalence of bipolar II disorder was 64.2%. The age at baseline and onset were significantly lower in bipolar II versus unipolar patients. All the other variables (MADRS items, duration of illness, severity, gender, psychosis, comorbidity, chronicity, recurrences) were not significantly different. The prevalence of bipolar II disorder among atypical depressed outpatients was higher than previously reported. Received: 27 July 1998 / Accepted: 19 January 1999     

The clinical picture of bipolar II outpatient depression in private practice

Uncertainties exist about whether depressive episodes differ phenomenologically in unipolar and bipolar II patients. The aim of the present study was to better define the clinical picture and course of bipolar II depression. Three hundred and ninety-nine consecutive outpatients, presenting for treatment of unipolar and bipolar II depression, were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery-Asberg Depression Rating Scale and the Global Assessment of Functioning Scale. Bipolar II depression had significantly lower age at onset, more recurrences and more patients with DSM-IV atypical features. Gender, duration of illness, psychosis, chronicity, severity, axis I comorbidity, melancholic features, individual atypical symptoms and other symptoms of depression were not significantly different. The presence of DSM-IV atypical features predicted bipolar II diagnosis with 63% probability.     

Gender Differences in Bipolar II and Unipolar Depressed Outpatients: A 557-Case Study

The aim of the present report was to study gender differences in bipolar II and in unipolar depressed outpatients. Consecutive 557 bipolar II and unipolar outpatients presenting for treatment of depression were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. Atypical features were significantly more common in bipolar II and in unipolar females than in males, in bipolar II females than in unipolar females, and in bipolar II males than in unipolar males. Female gender was significantly associated with atypical features, but not with diagnosis. Age at intake/onset, duration of illness, severity, recurrences, psychosis, and chronicity were not significantly different in bipolar II and in unipolar females and males (apart from comorbidity). Age at onset was significantly lower in bipolar II females than in unipolar females. This difference was not related to the higher prevalence of atypical features in bipolar II females.     

Should mood reactivity be included in the DSM-IV atypical features specifier?

Background The definition of atypical depression is still an unsolved issue. DSM-IV atypical features specifier criteria always require mood reactivity, but why mood reactivity should be included is unclear. The study aim was to test whether mood reactivity should be included in DSM-IV atypical features specifier. Methods Consecutively, 164 unipolar and 241 «soft» bipolar II major depressive episode (MDE) outpatients were interviewed with the Structured Clinical Interview for DSM-IV. The DSM-IV criteria for atypical features specifier were strictly followed. Associations were tested by univariate logistic regression. Results MDE with atypical features was present in 41.4 % of patients. Bipolar II disorder was significantly more common in patients with atypical features. MDE with atypical features was significantly associated with bipolar II, female gender, lower age of onset, more axis I comorbidity, fewer psychotic features, and more depressive mixed states. In the whole sample, mood reactivity was significantly associated with all the atypical symptoms, apart from leaden paralysis, and all the other atypical symptoms were significantly associated with each other. In the bipolar II sub-sample, mood reactivity was associated with many, but not all, atypical symptoms, while in the unipolar sub-sample it was associated with no atypical symptom. Atypical symptoms were significantly more common in mood reactive than in non-mood reactive patients, apart from leaden paralysis. Bipolar II disorder and mood reactivity were strongly associated. Conclusions Results may support the inclusion of mood reactivity in the DSM-IV atypical features specifier for bipolar II disorder, but not for unipolar depression.     

Sensitivity and specificity of DSM-IV atypical features for bipolar II disorder diagnosis

The aim of the study was to find the sensitivity and the specificity of DSM-IV atypical features (mood reactivity, weight gain, appetite increase, hypersomnia, leaden paralysis, interpersonal rejection sensitivity) for the diagnosis of bipolar II disorder. Consecutive 557 unipolar (54.9%) and bipolar II (45.0%) major depressive episode (MDE) outpatients were interviewed with the Structured Clinical Interview for DSM-IV and the Global Assessment of Functioning Scale. Bipolar II was diagnosed broadly, with a minimum duration of hypomania of at least some days, instead of the 4 days required by DSM-IV. MDE with atypical features was significantly more common in bipolar II patients. For the diagnosis of bipolar II disorder, MDE with atypical features, sensitivity was 0.45, and specificity was 0. 74. Among individual atypical features, hypersomnia had the best combination of sensitivity (0.35) and specificity (0.81). Combinations of two and three features did not improve sensitivity and specificity. As the diagnosis of past hypomania may not be very reliable from a patient's interview, atypical features may be an important marker of bipolar II disorder.     

Bipolar II Depression with Melancholic Features

Bipolar II depression with melancholic features has been understudied. The aims of the present study were to find the prevalence of melancholic features in bipolar II depression and in unipolar depression, and to compare melancholic with nonmelancholic bipolar II/ unipolar depression in private practice. One hundred and sixty two consecutive unipolar and bipolar II depressed outpatients were interviewed with the DSM-IV Structured Clinical Interview, the Montgomery–Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. Melancholic features were present in 19.2% of bipolar II patients and in 22.6% of unipolar patients, a nonsignificant difference. Melancholic bipolar II patients versus nonmelancholic bipolar II patients had significantly more psychosis and higher severity. All the other variables (age, age at onset, gender, illness duration, recurrences, atypical features, chronicity, comorbidity) were not significantly different. Melancholic bipolar II patients versus melancholic unipolar patients were not significantly different. Nonmelancholic bipolar II patients versus nonmelancholic unipolar patients had significantly lower age, lower age at onset, more atypical features, and more comorbidity. The prevalence of melancholic features in bipolar II depression in private practice was higher than previously reported in academic centers.     

Is there a link between atypical and early-onset "unipolar" depression and bipolar II disorder?

The aim of the present study was to determine whether there is a link between "unipolar" depression with atypical features and early onset, and bipolar II disorder, using atypical features and early onset as markers of bipolarity. A total of 158 consecutive unipolar and 234 bipolar II major depressive episode (MDE) outpatients were interviewed using the Structured Clinical Interview for DSM-IV (SCID). Patients were divided into those with and without atypical features, and into those with and without early onset. Comparisons were made on variables reported to distinguish bipolar from unipolar: age of onset, recurrences, atypical features, depressive mixed state (MDE plus three or more concurrent hypomanic symptoms [DMX3]), and bipolar II family history. Compared to bipolar II patients, patients with atypical unipolar were not significantly different regarding age of onset, DMX3, recurrences, and bipolar II family history. Compared to non-atypical unipolar patients, atypical unipolar patients had a significantly different age of onset. Nonatypical unipolar patients, versus bipolar II patients, were significantly different regarding age of onset, recurrences, DMX3, and bipolar II family history. Early onset unipolar, versus bipolar II, were not significantly different regarding atypical features, recurrences, DMX3, and bipolar II family history. Later onset unipolar patients, versus bipolar II patients, were significantly different regarding atypical features, recurrences, DMX3, and bipolar II family history. These results support a link of atypical and early-onset "unipolar" depression with bipolar II disorder, and support Pages and Dunner's suggestion to combine bipolar II and recurrent unipolar into a single group.     

Prevalence and clinical features of atypical depression in depressed outpatients: a 467-case study.

The prevalence of DSM-IV atypical depression and differences between atypical versus non-atypical depression were investigated in 467 unipolar and bipolar depressed outpatients in private practice. Consecutive outpatients presenting for treatment of a major depressive episode were assessed with the Comprehensive Assessment of Symptoms and History following DSM-IV criteria, the Montgomery-Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. The prevalence of atypical depression was 38.1%. Of the variables investigated (unipolar and bipolar diagnoses, age at onset, gender, psychosis, comorbidity, chronicity, duration of illness, recurrences, and severity), age at onset was significantly lower, and female gender, comorbidity, and bipolar II disorder were significantly more common in atypical than nonatypical depression. Comparisons between bipolar II atypical depression and unipolar atypical depression did not show significant differences, apart from age at onset. Findings suggest that there are important clinical differences between atypical and non-atypical depression in private practice outpatients.     

Atypical depressive symptoms and clusters in unipolar and bipolar depression

In order to examine differences in the atypical symptoms of depression between unipolar and bipolar patients, we studied 109 depressed patients (79 unipolar and 30 bipolar subjects) diagnosed with DSM-IV criteria. Patients were assessed using the Atypical Depression Diagnostic Scale (ADDS), a semi-structured interview that rates mood reactivity and other atypical depressive symptoms. Although atypical depression was common in this sample (28% of cases with definite atypical depression), no differences were found between the unipolar and bipolar patients in either the atypical symptom profile or the prevalence of an atypical depression diagnosis. The interrelationships between the atypical symptoms were also examined using a hierarchical cluster analysis. A five-cluster solution maximized differences between groups, with results suggesting that atypical depression may be a heterogeneous diagnosis.     

The Montgomery Asberg Depression Rating Scale in bipolar II and unipolar out-patients: A 405-patient case study

The aim of the present study was to find if the Montgomery Asberg Depression Rating Scale (MADRS) can identify symptom differences between bipolar II and unipolar depression. Four hundred and five consecutive bipolar II and unipolar depressed out-patients were interviewed with the Comprehensive Assessment of Symptoms and History structured interview, following DSM-IV criteria, the MADRS, and the Global Assessment of Functioning Scale. The Montgomery Asberg Depression Rating Scale items were not significantly different between bipolar II and unipolar patients. Comparisons among atypical and non-atypical bipolar II and unipolar patients showed that only MADRS items of 'reduced sleep' and 'reduced appetite' were significantly different between atypical and non-atypical patients.     

Agitated Depression: Unipolar? Bipolar? or Both?

The classification of agitated depression (major depressive episode (MDE) plus psychomotor agitation) in mood disorders is unclear. DSM-IV is neutral on this point. As antidepressants may increase agitation, a better understanding of agitated depression is important for clinical practice. Study aim was to find if agitated depression was closer to bipolar or to unipolar disorders, by studying its association with variables typically related to bipolar disorders (early onset, many recurrences, more atypical features, more bipolar family history), and by studying its association with bipolar II disorder. Consecutive 151 unipolar and 226 bipolar II psychoactive drug-free MDE outpatients were interviewed with the Structured Clinical Interview for DSM-IV, when presenting for MDE treatment. Agitated MDE patients were compared with nonagitated MDE patients. Statistics were t test for means, two-sample test of proportion, and logistic regression (STATA 7). Agitated MDE was present in 85 patients (22.5%). It had significantly more bipolar II disorder patients (80.0% vs. 54.1%, p = 0.0000), more females, lower age at onset, longer duration of illness, more MDE recurrences, more atypical features, more MDE symptoms, and more family history of bipolar disorders, than nonagitated MDE. To control for the possible confounding effect of bipolar II disorder, logistic regression was used. All the significant differences became nonsignificant. Results might suggest that agitated MDE might be closer to the bipolar spectrum than to unipolar disorder, because it was associated with variables typically distinguishing bipolar from unipolar disorders, and with bipolar II disorder. Further studies on this topic are needed.     

Depressive mixed states: unipolar and bipolar II

Depressive mixed states (DMS) (major depressive episodes with some hypomanic symptoms) are understudied, and not classified in DSM-IV. The study aim was to find prevalence of DMS among depressed outpatients, to study clinical differences between DMS and non-DMS, and relationships of DMS with unipolar and bipolar II. Ninety eight consecutive DSM-IV bipolar II and unipolar depressed outpatients were interviewed with the Structured Clinical Interview for DSM-IV. DMS was defined as an MDE with at least two concurrent hypomanic symptoms. DMS was present in 62.2% of patients [48.7% of unipolar, 71.9% of bipolar II, (p=0.022)]. DMS had significantly fewer unipolar, more bipolar II patients, lower age at onset, and more atypical features than non-DMS. Bipolar II DMS had significantly more recurrences, more atypical features, and lower age at onset (trend) than unipolar DMS. Bipolar II DMS had (trend) lower age at onset and more atypical features than bipolar II non-DMS. High DMS prevalence has important treatment implications, as antidepressants may worsen DMS, and some antidepressant-resistant depressions may be DMS responding to mood stabilizers. DMS may be distinct from non-DMS, but not from unipolar and bipolar II disorders, and this distinction may be due mainly to high bipolar II prevalence in DMS. Received: 16 February 2000 / Accepted: 31 May 2000     

Bipolar II versus unipolar chronic depression: a 312-case study

Differences between bipolar II depression and unipolar depression have been reported, such as a lower age at onset and more atypical features in bipolar II depression. The aim of the present study was to compare chronic/nonchronic bipolar II depression with chronic/nonchronic unipolar depression to determine whether the reported differences are present when chronicity is taken into account. Three hundred twelve outpatients in a bipolar II/unipolar major depressive episode were assessed with the Structured Clinical Interview for DSM-IV-Clinician Version (SCID-CV), the Montgomery and Asberg Depression Rating Scale (MADRS), and the Global Assessment of Functioning (GAF) Scale. No significant difference was found between chronic bipolar II and chronic unipolar depression (age at intake and onset, gender, duration of illness, recurrences, psychosis, atypical features, axis I comorbidity, and severity). A significantly lower age at onset and more atypical features were observed when comparing chronic/nonchronic bipolar II with nonchronic unipolar depression. These findings suggest that differences reported between bipolar II and unipolar depression are mainly due to nonchronic unipolar depression. Chronic unipolar depression may be a subtype intermediate between bipolar II depression and nonchronic unipolar depression.     

Atypical depression is associated with suicide attempt in bipolar disorder

Objective: There is a dearth of research focusing on factors associated with suicide attempts. High rates of atypical depression have been reported in studies including unipolar and bipolar II patients. In this study, the association between suicide attempt and atypical depression, in addition to other major risk factors, was evaluated in 390 bipolar I and II out‐patients. Method: Variables were defined according to DSM‐IV criteria, and assessed with a Structured Interview for DSM‐IV (axis I and II). History of suicide attempt was obtained through interviews with patients and relatives. Attempters and non‐attempters were compared using univariate and multivariate analysis. Results: Attempters showed significantly higher rates of atypical depression, family history of completed suicide, depression at index episode and cluster B personality disorder. Conclusion: Our results highlight the relevance of atypical depression in bipolar disorder. A more accurate identification of potential attempters may contribute to the development of effective preventive treatment strategies.     

The distinction of bipolar II disorder from bipolar I and recurrent unipolar depression: results of a controlled family study

The aim of the study was to differentiate bipolar II, bipolar I and recurrent unipolar depression by their familial load for affective disorders. Eighty bipolar, 108 unipolar, 80 control subjects and interviewed first-degree relatives were diagnosed according to Research Diagnostic Criteria using the Schedule for Affective Disorders and Schizophrenia – lifetime version. The morbid risks for bipolar I disorder were equivalent in relatives of bipolar I (3.6%) and bipolar II (3.5%) subjects and lower in relatives of unipolar subjects (1.0%). The morbid risks of relatives for bipolar II disorder distinguished bipolar II subjects (6.1%) from bipolar I subjects (1.8%), from unipolar depressives (0.3%) and from controls (0.5%). To promote further evaluation, bipolar II disorder should be included in DSM-IV as a distinct diagnostic category.     

Is 4 days the minimum duration of hypomania in bipolar II disorder?

DSM-IV requires that bipolar II disorder has hypomania with a minimum duration of 4 days, a cutoff not based on data. The study aim was to test if hypomania lasting 2 to 3 days could identify a group of bipolar II with typical clinical features of bipolar disorders. Consecutively, 65 unipolar and 103 bipolar II major depressive episode (MDE) outpatients were interviewed with the Structured Clinical Interview for DSM-IV. Almost all had had 2 to 3 days of hypomania, and all had had more than one hypomania. Typical clinical variables distinguishing bipolar from unipolar disorders (age at onset, atypical features, and recurrences) were compared. Bipolar II had significantly lower age at onset, more recurrences, and more atypical features. Findings suggest that hypomania lasting 2 to 3 days may identify a bipolar II group having typical features of bipolar disorders. Received: 27 September 2000 / Accepted: 6 November 2000     

Highly recurrent unipolar may be related to bipolar II

Unipolar and bipolar disorders may be subgroups of a single mood disorder, of which the key feature is not polarity, but the episodic, recurrent course. The aim of this study was to determine whether highly recurrent unipolar was related to bipolar II, by comparing clinical and family history features. Eighty-nine consecutive unipolar and 151 consecutive bipolar II outpatients, presenting for major depressive episode (MDE) treatment, were interviewed using the Structured Clinical Interview for DSM-IV (SCID) and the Family History Screen. Unipolar patients were divided into highly recurrent (>4 MDEs) (HRUP) and low recurrent (相似文献   

Clinical features of bipolar depression versus major depressive disorder in large multicenter trials

OBJECTIVE: Failure to recognize bipolar disorder in patients who experience a major depressive episode may lead to inappropriate treatment and poorer outcomes. Clinical features that could distinguish bipolar from unipolar depression would facilitate more appropriate treatment selection. METHOD: The authors used data from nonpsychotic outpatients participating in three large multicenter clinical trials conducted in the United States for the treatment of major depressive episodes to compare 477 subjects with a diagnosis of bipolar disorder and 1,074 with major depressive disorder. RESULTS: Bipolar depression was associated with family history of bipolar disorder, an earlier age at onset, a greater previous number of depressive episodes, and eight individual symptom items on the Montgomery-Asberg Depression Rating Scale and the Hamilton Anxiety Rating Scale. Fears were more common in patients with bipolar disorder, whereas sadness; insomnia; intellectual (cognitive), somatic (muscular), respiratory, genitourinary complaints; and depressed behavior were more common in patients with unipolar depression. A logistic regression model correctly classified 86.9% of the subjects. CONCLUSIONS: Bipolar depression and major depressive disorder exhibit subtle differences in presentation, which may help guide the initial diagnosis.     

单相抑郁与双相抑郁障碍临床特征的对照研究

目的探讨单相抑郁与双相抑郁障碍的临床特征和现象学上的异同。方法以单相抑郁144例和双相抑郁96例为研究对象，对两者一般资料及临床特征进行对照分析，以基线和治疗6周时汉密尔顿抑郁量表（HAMD）总分评价疗效。结果单相抑郁患者中家族史阳性率低，合并焦虑、自杀意念多见，治疗6周时总有效率为72．2％，而双相抑郁患者中伴激越、精神病性症状、不典型抑郁症状突出，治疗6周时总有效率为52．1％。结论单相抑郁与双相抑郁临床特征及现象学方面有所不同，单相抑郁治疗效果更好。发病年龄早、有家族史、外向个性、临床表现伴不典型抑郁表现等因素可能提示为双相抑郁。     

Unipolar depression with bipolar family history: links with the bipolar spectrum

The aim of the present paper was to find if unipolar major depressive disorder (MDD) with bipolar family history could be included in the bipolar spectrum, by comparing it to unipolar MDD without bipolar family history, and to bipolar II disorder, on typical bipolar variables. A sample of 280 consecutive bipolar II outpatients, and a sample of 135 consecutive unipolar MDD outpatients, presenting for major depressive episode (MDE) treatment, were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn). Hypomanic symptoms during the MDE were systematically assessed. Clinical variables used to validate the inclusion of unipolar MDD with bipolar family history in the bipolar spectrum were young age of onset, many MDE recurrences, atypical features, and depressive mixed state (DMX; an MDE plus >2 concurrent hypomanic symptoms), following many previous studies reporting that these variables were typical features of bipolar disorders. Means were compared by t-test and frequencies by chi2 test (stata 7). Two-tailed P < 0.05 was chosen. Unipolar MDD with bipolar family history was present in 20% of MDD patients. Comparisons among unipolar MDD with bipolar family history (UP+BPFH), unipolar MDD without bipolar family history (UP-BPFH), and bipolar II (BPII), found that UP+BPFH versus UP-BPFH had a significantly lower age, lower age of onset, fewer recurrences, and more DMX; that UP+BPFH versus BPII had no significant differences (apart from recurrences); and that UP-BPFH versus BPII had significantly different age, age of onset, recurrences, atypical features, and DMX. Findings suggest that UP+BPFH shows many bipolar signs, and that it could therefore be included in the bipolar spectrum. Unipolar MDD with bipolar family history had a clinically significant 20.0% frequency in the unipolar MDD sample, supporting the clinical usefulness of this depression subtype. The subtyping of MDD based on bipolar family history could have treatment implications.