Margherita Barbuti1, Lorenzo Mazzarini2, Eduard Vieta3, Jean-Michel Azorin4, Jules Angst5, Charles L Bowden6, Sergey Mosolov7, Allan H Young8, Giulio Perugi9. 1. Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Savi 10, 56126, Pisa, Italy. 2. NESMOS Department, School of Medicine and Psychology, Sapienza University, Rome, Italy; Salvator Mundi International Hospital, Rome, Italy. 3. Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. 4. Department of Psychiatry, Hôpital Sainte-Marguerite, Marseille, France. 5. Department of Psychiatry, Psychotherapy, and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. 6. Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA. 7. Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia. 8. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 9. Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Savi 10, 56126, Pisa, Italy. Electronic address: giulio.perugi@med.unipi.it.
Abstract
BACKGROUND: current classifications of mood disorders focus on polarity rather than recurrence, separating bipolar disorder from major depressive disorder (MDD). The aim of the present study is to explore the possible relationships between number and frequency of depressive episodes and clinical variables associated to bipolarity, in a large sample of MDD patients. METHODS: the clinical characteristics of 7055 patients with MDD were analyzed and compared according to the number and frequency of depressive episodes. Two stepwise backward logistic regression model were used to identify the predictive value of clinical features based on the presence of high number (≥3 episodes) and high frequency (≥3 episodes/year) of depressive episodes. RESULTS: high-recurrence and high-frequency MDD patients showed greater family history for bipolar disorder, higher prevalence of psychotic features, more suicide attempts, higher rates of treatment resistance and mood switches with antidepressants (ADs) and higher rates of bipolarity diagnosis according to Angst criteria, compared to low-recurrence and low-frequency patients. Logistic regressions showed that a brief current depressive episode, a previous history of treatment resistance and AD-induced mood switches, a diagnosis of bipolarity and comorbid borderline personality disorder were the variables associated with both high-recurrence and high-frequency depression. LIMITATIONS: the study participating centers were not randomly selected and several variables were retrospectively assessed. CONCLUSIONS: even in the absence of hypomanic/manic episodes, high-recurrence and high-frequency MDD seem to be in continuity with the bipolar spectrum disorders in terms of clinical features and, perhaps, treatment response.
BACKGROUND: current classifications of mood disorders focus on polarity rather than recurrence, separating bipolar disorder from major depressive disorder (MDD). The aim of the present study is to explore the possible relationships between number and frequency of depressive episodes and clinical variables associated to bipolarity, in a large sample of MDDpatients. METHODS: the clinical characteristics of 7055 patients with MDD were analyzed and compared according to the number and frequency of depressive episodes. Two stepwise backward logistic regression model were used to identify the predictive value of clinical features based on the presence of high number (≥3 episodes) and high frequency (≥3 episodes/year) of depressive episodes. RESULTS: high-recurrence and high-frequency MDDpatients showed greater family history for bipolar disorder, higher prevalence of psychotic features, more suicide attempts, higher rates of treatment resistance and mood switches with antidepressants (ADs) and higher rates of bipolarity diagnosis according to Angst criteria, compared to low-recurrence and low-frequency patients. Logistic regressions showed that a brief current depressive episode, a previous history of treatment resistance and AD-induced mood switches, a diagnosis of bipolarity and comorbid borderline personality disorder were the variables associated with both high-recurrence and high-frequency depression. LIMITATIONS: the study participating centers were not randomly selected and several variables were retrospectively assessed. CONCLUSIONS: even in the absence of hypomanic/manic episodes, high-recurrence and high-frequency MDD seem to be in continuity with the bipolar spectrum disorders in terms of clinical features and, perhaps, treatment response.
Authors: Péter Döme; Péter Kunovszki; Péter Takács; László Fehér; Tamás Balázs; Károly Dede; Siobhán Mulhern-Haughey; Sébastien Barbreau; Zoltán Rihmer Journal: PLoS One Date: 2021-01-20 Impact factor: 3.240