Major Depressive Disorder With Subthreshold Bipolarity in the National Comorbidity Survey Replication

Angst, Jules; Cui, Lihong; Swendsen, Joël; Rothen, Stéphane; Cravchik, Anibal; Kessler, Ronald C.; Merikangas, Kathleen R.

doi:10.1176/appi.ajp.2010.09071011

Cited by 268 publications

(268 citation statements)

References 36 publications

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“…8,17,20,21,34,35 The presence of irritability complicates the clinical picture of MDD with mixed features and may further increase treatment resistance to standard antidepressants. 6,[11][12][13][14][15] In the first prospective placebo-controlled trial in MDD with subthreshold hypomania (mixed features), lurasidone demonstrated significant efficacy in improving the symptoms of depression and subthreshold hypomanic symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…8 Prevalence estimates from clinical populations indicate that mixed features occur in at least 25% of patients with MDD. 11,14,[16][17][18][19][20][21][22] Irritability is not included as a criterion for mixed features in DSM-5, in part due to concerns regarding specificity. 8 Despite the prevalence and prognostic significance of irritability in MDD (with or without mixed features), few prospective studies have examined treatment response in this important clinical population.…”

Section: Introductionmentioning

confidence: 99%

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Lurasidone for major depressive disorder with mixed features and irritability: a post-hoc analysis

et al. 2017

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Objective. The aim of this post-hoc analysis was to evaluate the efficacy of lurasidone in treating major depressive disorder (MDD) with mixed features including irritability.Methods. The data in this analysis were derived from a study of patients meeting DSM-IV-TR criteria for unipolar MDD, with a Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≥26, presenting with two or three protocol-defined manic symptoms, and who were randomized to 6 weeks of double-blind treatment with either lurasidone 20-60 mg/d (n = 109) or placebo (n = 100). We defined "irritability" as a score ≥2 on both the Young Mania Rating Scale (YMRS) irritability item (#5) and the disruptive-aggressive item (#9). Endpoint change in the MADRS and YMRS items 5 and 9 were analyzed using a mixed model for repeated measures for patients with and without irritability.Results. Some 20.7% of patients met the criteria for irritability. Treatment with lurasidone was associated with a significant week 6 change vs. placebo in MADRS score in both patients with (-22.6 vs. -9.5, p < 0.0001, effect size [ES] = 1.4) and without (-19.9 vs. -13.8, p < 0.0001, ES = 0.7) irritability. In patients with irritable features, treatment with lurasidone was associated with significant week 6 changes vs. placebo in both the YMRS irritability item (-1.4 vs. -0.3, p = 0.0012, ES = 1.0) and the YMRS disruptive-aggressive item (-1.0 vs. -0.3, p = 0.0002, ES = 1.2).Conclusions. In our post-hoc analysis of a randomized, placebo-controlled, 6-week trial, treatment with lurasidone significantly improved depressive symptoms in MDD patients with mixed features including irritability. In addition, irritability symptoms significantly improved in patients treated with lurasidone.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lurasidone for major depressive disorder with mixed features and irritability: a post-hoc analysis

et al. 2017

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“…[2][3][4][5][6][7][8][9][10][11][12] In MDD patients without mixed features, the presence of concurrent anxiety has been shown to reduce the likelihood of achieving an adequate antidepressant response. [19][20][21][22][23][24][25][26][27] We report here the results of a post-hoc analysis of a placebo-controlled, 6-week trial of MDD presenting with mixed features and anxiety which found that treatment with lurasidone significantly improved depressive symptoms in a subgroup of patients with moderate-to-severe anxiety at baseline.…”

Section: Lurasidone For Mdd With Mixed Features and Anxiety 241mentioning

confidence: 99%

“…1 The available evidence, largely from clinical study populations, suggests that major depressive disorder (MDD) with mixed features may occur in at least 25% of patients with major depression. [2][3][4][5][6][7][8][9][10][11][12] In patients with a diagnosis of MDD, the estimated lifetime prevalence of an anxiety disorder is greater than 35%. 13,14 The presence of comorbid anxiety in MDD has been found to be associated with greater illness severity, chronicity, and functional impairment.…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17][18] Preliminary research suggests that patients with a diagnosis of MDD with mixed features (subthreshold hypomania) may have rates of anxiety comorbidity in the range of 45-65%. 3,11 MDD with mixed features is also associated with higher severity of concurrent anxiety symptoms. [10][11][12] High levels of anxiety have frequently been reported to reduce the likelihood of achieving an adequate antidepressant response in patients with both unipolar MDD [19][20][21][22][23][24][25][26][27] and bipolar depression.…”

Section: Introductionmentioning

confidence: 99%

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Lurasidone for major depressive disorder with mixed features and anxiety: a post-hoc analysis of a randomized, placebo-controlled study

et al. 2017

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Objective. The aim of this post-hoc analysis was to evaluate the efficacy of lurasidone in treating patients with major depressive disorder (MDD) with mixed features who present with mild and moderate-to-severe levels of anxiety.Methods. The data in this analysis were derived from a study of patients meeting the DSM-IV-TR criteria for unipolar MDD, with a Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≥26, presenting with two or three protocol-defined manic symptoms, who were randomized to 6 weeks of double-blind treatment with either lurasidone 20-60 mg/day (n = 109) or placebo (n = 100). Anxiety severity was evaluated using the Hamilton Anxiety Rating Scale (HAM-A). To evaluate the effect of baseline anxiety on response to lurasidone, the following two anxiety groups were defined: mild anxiety (HAM-A ≤ 14) and moderate-to-severe anxiety (HAM-A ≥ 15). Change from baseline in MADRS total score was analyzed for each group using a mixed model for repeated measures.Results. Treatment with lurasidone was associated with a significant week 6 change versus placebo in MADRS total score for patients with both mild anxiety (-18.4 vs. -12.8, p < 0.01, effect size [ES] = 0.59) and moderate-to-severe anxiety (-22.0 vs. -13.0, p < 0.001, ES = 0.95). Treatment with lurasidone was associated with a significant week 6 change versus placebo in HAM-A total score for patients with both mild anxiety (-7.6 vs. -4.0, p < 0.01, ES = 0.62), and moderate-to-severe anxiety (-11.4 vs. -6.1, p < 0.0001, ES = 0.91).Conclusions. In this post-hoc analysis of an MDD with mixed features and anxiety population, treatment with lurasidone was associated with significant improvement in both depressive and anxiety symptoms in subgroups with mild and moderate-to-severe levels of anxiety at baseline.

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Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative

Merikangas¹,

Jin²,

He³

et al. 2011

Arch Gen Psychiatry

2,057

1,351

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Context There is limited information on the prevalence and correlates of bipolar spectrum disorder in international population-based studies using common methodology. Objective To describe the prevalence, impact, patterns of comorbidity, and patterns of service utilization for bipolar spectrum disorder in the WHO World Mental Health survey (WMH) initiative. Design Cross-sectional face-to-face household surveys Participants 61,392 community adults in 11 countries in the Americas, Europe, and Asia Main Outcome Measure DSM-IV disorders, severity, and treatment assessed with the World Mental Health version of the WHO Composite International Diagnostic Interview (WMH CIDI 3.0), a fully-structured lay-administered psychiatric diagnostic interview. Results The aggregate lifetime prevalence of BP-I disorder was 0.6%, BP-II was 0.4%, subthreshold BP was 1.4%, and Bipolar Spectrum (BPS) was 2.4%. Twelve-month prevalence of BP-I disorder was 0.4%, BP-II was 0.3%, subthreshold BP was 0.8%, and BPS was 1.5%. Severity of both manic and depressive symptoms, and suicidal behavior increased monotonically from subthreshold BP to BP-I. By contrast, role impairment was similar across bipolar subtypes. Symptom severity was greater for depressive than manic episodes, with approximately 75% of respondents with depression and 50% of respondents with mania reporting severe role impairment. Three-quarters of those with BPS met criteria for at least one other disorder, with anxiety disorders, particularly panic attacks, being the most common comorbid condition. Less than half of those with lifetime BPS received mental health treatment, particularly in low-income countries where only 25% reported contact with the mental health system. Conclusions Despite cross-site variation in the prevalence rates of bipolar spectrum disorder, the severity, impact, and patterns of comorbidity were remarkably similar internationally. The uniform increases in clinical correlates, suicidal behavior and comorbidity across each diagnostic category provide evidence for the validity of the concept of a bipolar spectrum. BPS treatment needs are often unmet, particularly in low-income countries.

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Major Depressive Disorder With Subthreshold Bipolarity in the National Comorbidity Survey Replication

Cited by 268 publications

References 36 publications

Lurasidone for major depressive disorder with mixed features and irritability: a post-hoc analysis

Lurasidone for major depressive disorder with mixed features and irritability: a post-hoc analysis

Lurasidone for major depressive disorder with mixed features and anxiety: a post-hoc analysis of a randomized, placebo-controlled study

Prevalence and Correlates of Bipolar Spectrum Disorder in the World Mental Health Survey Initiative

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