Hyewon Kim1, Yuwon Kim2, Ji Hyun Baek1, Maurizio Fava3, David Mischoulon3, Andrew A Nierenberg4, Kwan Woo Choi5, Eun Jin Na1, Myung-Hee Shin6, Hong Jin Jeon7. 1. Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135770, South Korea. 2. Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea. 3. Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States. 4. Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States; Bipolar Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. 5. Department of Psychiatry, Anam Hospital, Korea University College of Medicine and School of Medicine, Seoul, South Korea. 6. Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea. 7. Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135770, South Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea. Electronic address: jeonhj@skku.edu.
Abstract
BACKGROUND: Predicting patients who convert to bipolar disorder is important for deciding appropriate treatment for young adults with major depressive disorder (MDD). We focused on the predictive factors of bipolar conversion in a large population of young adults. METHODS: A nationwide, population-based electronic medical records database from the Health Insurance Review & Assessment service of South was used to investigate adjusted hazard ratio (HR) of each potential predictor of the bipolar converter group compared to the non-converter group using Cox regression analysis including age of onset, medication use, clinical features, comorbid disorders, admission, self-harm, and negative life events in childhood. RESULTS: Among 291,721 subjects who were initially diagnosed with MDD in young adults, 12,376 subjects experienced diagnostic conversion to bipolar disorder. The cumulative incidence was 6.46% during the average 3.26 years of follow-up. Among the predictive factors during diagnosis of MDD, antipsychotic use (HR 3.12, 95%CI, 2.99-3.26, p < 0.0001) and mood stabilizers (HR 2.45, 95%CI, 2.35-2.55, p < 0.0001) showed the strongest association with diagnostic conversion to bipolar disorder. In addition, female sex, younger age of onset, mood stabilizer use, recurrent depression, psychotic symptoms, and admission to a psychiatric ward during diagnosis of MDD were also associated with diagnostic conversion to bipolar disorder. CONCLUSION: In young adults with MDD, antipsychotic and mood stabilizer use during diagnosis of MDD were the strongest predictive factors with diagnostic conversion to bipolar disorder during follow-up. If young adults with MDD need antipsychotics or mood stabilizer, patients should be carefully evaluated for possibility of bipolar disorder.
BACKGROUND: Predicting patients who convert to bipolar disorder is important for deciding appropriate treatment for young adults with major depressive disorder (MDD). We focused on the predictive factors of bipolar conversion in a large population of young adults. METHODS: A nationwide, population-based electronic medical records database from the Health Insurance Review & Assessment service of South was used to investigate adjusted hazard ratio (HR) of each potential predictor of the bipolar converter group compared to the non-converter group using Cox regression analysis including age of onset, medication use, clinical features, comorbid disorders, admission, self-harm, and negative life events in childhood. RESULTS: Among 291,721 subjects who were initially diagnosed with MDD in young adults, 12,376 subjects experienced diagnostic conversion to bipolar disorder. The cumulative incidence was 6.46% during the average 3.26 years of follow-up. Among the predictive factors during diagnosis of MDD, antipsychotic use (HR 3.12, 95%CI, 2.99-3.26, p < 0.0001) and mood stabilizers (HR 2.45, 95%CI, 2.35-2.55, p < 0.0001) showed the strongest association with diagnostic conversion to bipolar disorder. In addition, female sex, younger age of onset, mood stabilizer use, recurrent depression, psychotic symptoms, and admission to a psychiatric ward during diagnosis of MDD were also associated with diagnostic conversion to bipolar disorder. CONCLUSION: In young adults with MDD, antipsychotic and mood stabilizer use during diagnosis of MDD were the strongest predictive factors with diagnostic conversion to bipolar disorder during follow-up. If young adults with MDD need antipsychotics or mood stabilizer, patients should be carefully evaluated for possibility of bipolar disorder.
Authors: Anastasiya Nestsiarovich; Jenna M Reps; Michael E Matheny; Scott L DuVall; Kristine E Lynch; Maura Beaton; Xinzhuo Jiang; Matthew Spotnitz; Stephen R Pfohl; Nigam H Shah; Carmen Olga Torre; Christian G Reich; Dong Yun Lee; Sang Joon Son; Seng Chan You; Rae Woong Park; Patrick B Ryan; Christophe G Lambert Journal: Transl Psychiatry Date: 2021-12-20 Impact factor: 6.222
Authors: Silvia Biere; Thorsten M Kranz; Silke Matura; Kristiyana Petrova; Fabian Streit; Andreas G Chiocchetti; Oliver Grimm; Murielle Brum; Natalie Brunkhorst-Kanaan; Viola Oertel; Aliaksandr Malyshau; Andrea Pfennig; Michael Bauer; Thomas G Schulze; Sarah Kittel-Schneider; Andreas Reif Journal: Front Psychiatry Date: 2020-10-26 Impact factor: 4.157