TY - JOUR
T1 - Hypomanic symptoms in major depressive disorder
T2 - Prognostic impact and treatment issues
AU - Olgiati, Paolo
AU - Kasper, Siegfried
AU - Zohar, Joseph
AU - Souery, Daniel
AU - Montgomery, Stuart
AU - Ferentinos, Panagiotis
AU - Rujescu, Dan
AU - Zanardi, Raffaella
AU - Fugger, Gernot
AU - Ferri, Raffaele
AU - Tripodi, Mariangela
AU - Baune, Bernhard T
AU - Fabbri, Chiara
AU - Mendlewicz, Julien
AU - Serretti, Alessandro
N1 - Publisher Copyright:
© 2024 Elsevier B.V.
PY - 2025/1/15
Y1 - 2025/1/15
N2 - Background: Mixed depression (MXD), defined as (hypo)manic symptoms occurring within major depressive episodes, is common in both bipolar and unipolar disorders, but its prognostic and treatment implications remain unclear. This study aimed to examine the relationship between hypomanic symptoms, treatment response and remission of suicidal thoughts. Methods: We analyzed 1243 adults with major depressive disorder (MDD), recruited for a naturalistic study on treatment-resistant depression. Data were gathered cross-sectionally and retrospectively through structured interviews and clinical rating scales including the Young Mania Rating Scale (YMRS) and Montgomery-Asberg Depression Rating Scale (MADRS); statistical analyses were performed using univariate and multivariate methods. Results: Hypomanic symptoms were present in 651 patients (45 %), while 307 patients (25 %) responded to treatment. Both treatment responders (p < 0.0001) and those who achieved remission from suicide ideation (p = 0.0085) showed lower hypomanic (YMRS) scores. Multivariate analysis showed that hypomanic symptoms were negatively linked to treatment response (O.R. 0.71–0.87), while bipolar spectrum markers such as age at illness onset (O.R. 1.00–1.03) and MDD recurrence (O.R. 0.47–0.89) predicted remission from suicidal thoughts. Medications commonly used to treat bipolar disorder showed some benefits, with dopamine/serotonin antagonists improving suicide ideation (p < 0.0001) and mood stabilizers being associated with reduced hypomanic symptoms (p = 0.0003). Limitations: The study lacked prospective clinical assessments and treatment randomization. Conclusion: Hypomanic symptoms are common in unipolar depression; their assessment is essential to identify challenging-to-treat cases and select the best pharmacological options.
AB - Background: Mixed depression (MXD), defined as (hypo)manic symptoms occurring within major depressive episodes, is common in both bipolar and unipolar disorders, but its prognostic and treatment implications remain unclear. This study aimed to examine the relationship between hypomanic symptoms, treatment response and remission of suicidal thoughts. Methods: We analyzed 1243 adults with major depressive disorder (MDD), recruited for a naturalistic study on treatment-resistant depression. Data were gathered cross-sectionally and retrospectively through structured interviews and clinical rating scales including the Young Mania Rating Scale (YMRS) and Montgomery-Asberg Depression Rating Scale (MADRS); statistical analyses were performed using univariate and multivariate methods. Results: Hypomanic symptoms were present in 651 patients (45 %), while 307 patients (25 %) responded to treatment. Both treatment responders (p < 0.0001) and those who achieved remission from suicide ideation (p = 0.0085) showed lower hypomanic (YMRS) scores. Multivariate analysis showed that hypomanic symptoms were negatively linked to treatment response (O.R. 0.71–0.87), while bipolar spectrum markers such as age at illness onset (O.R. 1.00–1.03) and MDD recurrence (O.R. 0.47–0.89) predicted remission from suicidal thoughts. Medications commonly used to treat bipolar disorder showed some benefits, with dopamine/serotonin antagonists improving suicide ideation (p < 0.0001) and mood stabilizers being associated with reduced hypomanic symptoms (p = 0.0003). Limitations: The study lacked prospective clinical assessments and treatment randomization. Conclusion: Hypomanic symptoms are common in unipolar depression; their assessment is essential to identify challenging-to-treat cases and select the best pharmacological options.
KW - Humans
KW - Depressive Disorder, Major/drug therapy
KW - Female
KW - Male
KW - Adult
KW - Middle Aged
KW - Suicidal Ideation
KW - Prognosis
KW - Retrospective Studies
KW - Cross-Sectional Studies
KW - Mania/drug therapy
KW - Psychiatric Status Rating Scales
KW - Antidepressive Agents/therapeutic use
KW - Depressive Disorder, Treatment-Resistant/drug therapy
KW - Bipolar Disorder/drug therapy
KW - Treatment Outcome
KW - Treatment-resistant depression
KW - Mood stabilizers
KW - Hypomanic symptoms
KW - Major depressive disorder
KW - Unipolar depression
KW - Antidepressant response
UR - http://www.scopus.com/inward/record.url?scp=85207602072&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2024.10.104
DO - 10.1016/j.jad.2024.10.104
M3 - Journal article
C2 - 39447979
SN - 0165-0327
VL - 369
SP - 1021
EP - 1030
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -