Eun Young Kim1, Nam Woo Kim2, Min Ji Kim2, Bo Ram Yang3, Sang Jin Rhee2, C Hyung Keun Park4, Hyun Jeong Lee5, Se Hyun Kim2, Yong Min Ahn6. 1. Mental Health Center, Seoul National University Health Care Center, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea; Department of Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. 2. Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. 3. Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. 4. Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea. 5. Mental Health Clinic, National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do 10326, Republic of Korea; Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do 10326, Republic of Korea. 6. Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Institute of Human Behavioral Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. Electronic address: aym@snu.ac.kr.
Abstract
BACKGROUND: Patients with bipolar disorder (BD) and depressive episodes are usually diagnosed with major depressive disorder (MDD). It is clinically important to estimate diagnostic conversion rate from MDD to BD and identify factors characterizing MDD patients at highest risk. We investigated conversion rate from depression to BD, stratified by age and sex, and associated psychopharmacological treatment patterns. METHODS: Data were extracted from the National Health Insurance to include 817,759 patients 18 years or older with new-onset antidepressant-treated depression between 2011 and 2015. We estimated rate of conversion from unipolar depression to BD stratified by age and sex during follow-up (357,343 person-years) and investigated the related medication patterns. RESULTS: During follow-up (median, 155 days; range, 2-1,442 days), 19,179 patients had diagnostic conversion to BD. Conversion rate was highest for patients aged 18-29 years; it gradually decreased with age until 60-69 years. Overall conversion rate to BD was 58.48 per 1,000 person-years for males and 50.97 per 1,000 person-years for females. For patients aged 18-39 years, the rate was higher for females. Patients with conversion to BD were prescribed more antidepressants. When the diagnosis changed to BD, 51% of patients were prescribed additional antipsychotics and/or mood stabilizers. LIMITATIONS: The limited follow-up period may have underestimated conversion rate to BD. Data were restricted to participants with pharmaceutically treated depression. CONCLUSIONS: The rate of diagnostic conversion from depression to BD differed by sex and age and was highest for females aged 18-29 years. Diagnostic conversion was accompanied by relevant prescription changes.
BACKGROUND:Patients with bipolar disorder (BD) and depressive episodes are usually diagnosed with major depressive disorder (MDD). It is clinically important to estimate diagnostic conversion rate from MDD to BD and identify factors characterizing MDDpatients at highest risk. We investigated conversion rate from depression to BD, stratified by age and sex, and associated psychopharmacological treatment patterns. METHODS: Data were extracted from the National Health Insurance to include 817,759 patients 18 years or older with new-onset antidepressant-treated depression between 2011 and 2015. We estimated rate of conversion from unipolar depression to BD stratified by age and sex during follow-up (357,343 person-years) and investigated the related medication patterns. RESULTS: During follow-up (median, 155 days; range, 2-1,442 days), 19,179 patients had diagnostic conversion to BD. Conversion rate was highest for patients aged 18-29 years; it gradually decreased with age until 60-69 years. Overall conversion rate to BD was 58.48 per 1,000 person-years for males and 50.97 per 1,000 person-years for females. For patients aged 18-39 years, the rate was higher for females. Patients with conversion to BD were prescribed more antidepressants. When the diagnosis changed to BD, 51% of patients were prescribed additional antipsychotics and/or mood stabilizers. LIMITATIONS: The limited follow-up period may have underestimated conversion rate to BD. Data were restricted to participants with pharmaceutically treated depression. CONCLUSIONS: The rate of diagnostic conversion from depression to BD differed by sex and age and was highest for females aged 18-29 years. Diagnostic conversion was accompanied by relevant prescription changes.
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