Agitated depression in bipolar disorder

Abstract

Objectives It has been suggested that agitated depression (AD) is a common, severe feature in bipolar disorder. We aimed to estimate the prevalence of AD and investigate whether presence of AD was associated with episodic and lifetime clinical features in a large well‐characterized bipolar disorder sample. Method The prevalence of agitation, based on semi‐structured interview and medical case‐notes, in the most severe depressive episode was estimated in 2925 individuals with DSM‐IV bipolar disorder recruited into the UK Bipolar Disorder Research Network. Predictors of agitation were ascertained using symptoms within the same episode and lifetime clinical features using multivariate models. Results 32.3% (n = 946) experienced agitation during the worst depressive episode. Within the same episode, significant predictors of presence of agitation were: insomnia (OR 2.119, P < 0.001), poor concentration (OR 1.966, P = 0.027), decreased libido (OR 1.960, P < 0.001), suicidal ideation (OR 1.861, P < 0.001), slowed activity (OR 1.504, P = 0.001), and poor appetite (OR 1.297, P = 0.029). Over the lifetime illness course, co‐morbid panic disorder (OR 2.000, P < 0.001), suicide attempt (OR 1.399, P = 0.007), and dysphoric mania (OR 1.354, P = 0.017) were significantly associated with AD. Conclusions Agitation accompanied bipolar depression in at least one‐third of cases in our sample and was associated with concurrent somatic depressive symptoms, which are also common features of mixed manic states. Furthermore, AD in our sample was associated with lifetime experience of mixed mania, in addition to severe lifetime illness course including comorbid panic disorder and suicidal behavior. Our results have implications for the diagnosis and treatment of agitated features in bipolar depression.

Accelerated low-intensity rTMS does not rescue anxiety behaviour or abnormal connectivity in young adult rats following chronic restraint stress

“…Hyperactivity has been reported in other animal models of depression, such as olfactory bulbectomy in mice ( Heath et al, 2018 ; Masini et al, 2004 ; Wang et al, 2007 ), and is a common clinical symptom of depression in some human patients ( Serra et al, 2019 ; Iwanami et al, 2015 ; Angst et al, 2009 ). Moreover, psychomotor agitation is a common symptom of anxiety disorders, particularly when comorbidities of anxiety and mood disorders are present ( Kaiser et al, 2021 ; Zbozinek et al, 2012 ).…”

Is the 4-factor model of symptomology equivalent across bipolar disorder subtypes?

“…Irritability and anger outbursts occur under both definitions, but there is an interpersonal aspect to affrontive symptoms absent from current understanding of agitated depression. And as noted by Serra et al (2019), agitation co-occurs with depression not hypo/mania, in particular, decreased libido, poor concentration, and suicidal ideation. With agitated depression, patients sometimes describe an underlying sense of anxiety or unease; with affrontive symptoms, the driving emotion is anger, often rage.…”

Factors associated with single versus multiple suicide attempts in depressive disorders

“…They include high rates of suicide attempts among patients diagnosed with bipolar disorder (BD), and in association with major depressive disorder (MDD), especially if severe enough as to require hospitalization [Galfalvy et al 2006;Oquendo et al 2006;Zalsman et al 2006;Simon et al 2007;Novick et al 2010;Bellivier et al 2011;Undurraga et al 2012;Hawton et al 2013;Pawlak et al 2013;Holma et al 2014;Tondo et al 2016;Baldessarini et al 2019;. Presence of mixed features (agitation, hypomanic symptoms) with depression also is an important risk factor for suicidal behavior [Hawton et al 2005;Azorin et al 2009;Tondo et al 2018Tondo et al , 2020Baldessarini et al 2019;Brancati et al 2019;Lage et al 2019;Serra et al 2019]. Additional risk factors include mood instability [McDonald et al 2007;Peters et al 2016], switching between depression and mania [Perlis et al 2010;Niitsu et al 2015;de Azevedo Cardoso et al 2018], and poor response to treatment of depression [Bergfeld et al 2018;Reutfors et al 2019]-all probably related to BD.…”