BACKGROUND: This report describes baseline characteristics and functional outcomes of subjects who have prospectively observed subsyndromal symptoms after a major depressive episode (MDE). METHODS: All subjects were participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). We identified subjects with at least 2 years of observation whose prior or current episode was a MDE, and who were in a stable clinical state of either recovered (no more than 2 moderate symptoms for at least 8 weeks), a MDE by DSM-IV criteria, or with continued subsyndromal symptoms. The subsyndromal group was defined a priori as 3 or more moderate affective symptoms but without meeting diagnostic criteria for major depression. RESULTS: The final cohort included 1094 recovered, 112 subsyndromal, and 310 individuals in a MDE. The average time spent in each clinical status ranged from 120 to 132 days. The subsyndromal group was most similar to those in a MDE, differing only on the intensity of depressive symptoms and the number of work days missed due to ongoing symptoms. Reported sadness, inability to feel and lassitude were each associated with multiple measures of impairment. LIMITATIONS: This study is limited by the cross-sectional approach to defining outcomes. CONCLUSIONS: These findings are consistent with studies in unipolar major depression that indicate that functional impairment observed in the context of subsyndromal depressive symptoms is comparable to that of a full episode. This work underscores the need to include subsyndromal symptoms in study outcomes and to target full remission in clinical practice.
BACKGROUND: This report describes baseline characteristics and functional outcomes of subjects who have prospectively observed subsyndromal symptoms after a major depressive episode (MDE). METHODS: All subjects were participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). We identified subjects with at least 2 years of observation whose prior or current episode was a MDE, and who were in a stable clinical state of either recovered (no more than 2 moderate symptoms for at least 8 weeks), a MDE by DSM-IV criteria, or with continued subsyndromal symptoms. The subsyndromal group was defined a priori as 3 or more moderate affective symptoms but without meeting diagnostic criteria for major depression. RESULTS: The final cohort included 1094 recovered, 112 subsyndromal, and 310 individuals in a MDE. The average time spent in each clinical status ranged from 120 to 132 days. The subsyndromal group was most similar to those in a MDE, differing only on the intensity of depressive symptoms and the number of work days missed due to ongoing symptoms. Reported sadness, inability to feel and lassitude were each associated with multiple measures of impairment. LIMITATIONS: This study is limited by the cross-sectional approach to defining outcomes. CONCLUSIONS: These findings are consistent with studies in unipolar major depression that indicate that functional impairment observed in the context of subsyndromal depressive symptoms is comparable to that of a full episode. This work underscores the need to include subsyndromal symptoms in study outcomes and to target full remission in clinical practice.
Authors: P E Keck; S L McElroy; S M Strakowski; S A West; K W Sax; J M Hawkins; M L Bourne; P Haggard Journal: Am J Psychiatry Date: 1998-05 Impact factor: 18.112
Authors: T J Craig; E J Bromet; L Jandorf; S Fennig; M Tanenberg-Karant; R Ram; B Rosen Journal: Ann Clin Psychiatry Date: 1997-06 Impact factor: 1.567
Authors: L L Judd; H S Akiskal; J D Maser; P J Zeller; J Endicott; W Coryell; M P Paulus; J L Kunovac; A C Leon; T I Mueller; J A Rice; M B Keller Journal: Arch Gen Psychiatry Date: 1998-08
Authors: D V Sheehan; Y Lecrubier; K H Sheehan; P Amorim; J Janavs; E Weiller; T Hergueta; R Baker; G C Dunbar Journal: J Clin Psychiatry Date: 1998 Impact factor: 4.384
Authors: B Shapira; J Zislin; Y Gelfin; Y Osher; M Gorfine; D Souery; J Mendlewicz; B Lerer Journal: Compr Psychiatry Date: 1999 Jan-Feb Impact factor: 3.735
Authors: Thomas C Baghai; Pierre Blier; David S Baldwin; Michael Bauer; Guy M Goodwin; Kostas N Fountoulakis; Siegfried Kasper; Brian E Leonard; Ulrik F Malt; Dan Stein; Marcio Versiani; Hans-Jürgen Möller Journal: Eur Arch Psychiatry Clin Neurosci Date: 2011-11 Impact factor: 5.270
Authors: Lakshmi N Yatham; Sidney H Kennedy; Sagar V Parikh; Ayal Schaffer; David J Bond; Benicio N Frey; Verinder Sharma; Benjamin I Goldstein; Soham Rej; Serge Beaulieu; Martin Alda; Glenda MacQueen; Roumen V Milev; Arun Ravindran; Claire O'Donovan; Diane McIntosh; Raymond W Lam; Gustavo Vazquez; Flavio Kapczinski; Roger S McIntyre; Jan Kozicky; Shigenobu Kanba; Beny Lafer; Trisha Suppes; Joseph R Calabrese; Eduard Vieta; Gin Malhi; Robert M Post; Michael Berk Journal: Bipolar Disord Date: 2018-03-14 Impact factor: 6.744
Authors: Susie A Hales; Martina Di Simplicio; Lalitha Iyadurai; Simon E Blackwell; Kerry Young; Christopher G Fairburn; John R Geddes; Guy M Goodwin; Emily A Holmes Journal: Behav Cogn Psychother Date: 2018-07-09
Authors: Kristen M Abraham; Christopher J Miller; Denis G Birgenheir; Zongshan Lai; Amy M Kilbourne Journal: J Nerv Ment Dis Date: 2014-08 Impact factor: 2.254