Hypomanic symptoms in major depressive disorder: Prognostic impact and treatment issues

Paolo Olgiati, Siegfried Kasper, Joseph Zohar, Daniel Souery, Stuart Montgomery, Panagiotis Ferentinos, Dan Rujescu, Raffaella Zanardi, Gernot Fugger, Raffaele Ferri, Mariangela Tripodi, Bernhard T Baune, Chiara Fabbri, Julien Mendlewicz, Alessandro Serretti*

*Korrespondierende:r Autor:in für diese Arbeit

Publikation: Beitrag in Fachzeitschrift (peer-reviewed)Artikel in Fachzeitschrift

1 Zitat (Scopus)

Abstract

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.

OriginalspracheEnglisch
Seiten (von - bis)1021-1030
Seitenumfang10
FachzeitschriftJournal of Affective Disorders
Jahrgang369
DOIs
PublikationsstatusVeröffentlicht - 15 Jan. 2025

ASJC Scopus Sachgebiete

  • Klinische Psychologie
  • Psychiatrie und psychische Gesundheit

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