Mixed symptoms in major depressive and bipolar disorders: A systematic review

Vázquez, Gustavo; Lolich, María; Cabrera, Casimiro; Jokic, Ruzica; Kolář, Dušan; Tondo, Leonardo; Baldessarini, Ross J.

doi:10.1016/j.jad.2017.09.006

Cited by 51 publications

(40 citation statements)

References 48 publications

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“…Among BD patients, suicide risk remains high despite the growing variety of treatments with effective mood-stabilizing effects [13]. This disparity almost certainly reflects the great difficulty of effectively treating depressive and mixed manic-depressive states of BD [14][15][16][17][18][19][20][21], which represent the majority of residual morbidity with clinically applied long-term treatments [22][23][24]. Modern psychiatric treatments, rapid hospitalization, and even electroconvulsive treatment (ECT) may be useful as short-term interventions but lack evidence of long-term suicide preventive effects [25][26][27][28][29].…”

Section: Resultsmentioning

confidence: 99%

Antisuicidal Effects in Mood Disorders: Are They Unique to Lithium?

Tondo

Baldessarini

2018

Pharmacopsychiatry

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Section: Resultsmentioning

confidence: 99%

Antisuicidal Effects in Mood Disorders: Are They Unique to Lithium?

Tondo

Baldessarini

2018

Pharmacopsychiatry

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“…18,19 Particularly of note, the present findings also support a wellknown, strong association of suicidal risk with mixed features, including patients diagnosed with either BD or MDD (Table 2). 9,[20][21][22][23] Elements that may connect BD, mixed states and suicidal risk include aggressiveness and other mania-associated characteristics in both juveniles and adults. 24,25 Violent methods of suicide or attempts were identified in 28.4% (95% CI 7.21-49.6) of all suicidal acts (attempts + suicides), more with a diagnosis of BD-I than BD-II or MDD (Table 1) and, as expected, [26][27][28] more with suicides than attempts, and more among men than women.…”

Section: Discussionmentioning

confidence: 99%

Suicidal risk factors in major affective disorders

Baldessarini

Tondo

Pinna³

et al. 2019

Br J Psychiatry

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BackgroundRates and risk factors for suicidal behaviour require updating and comparisons among mood disorders.AimsTo identify factors associated with suicidal risk in major mood disorders.MethodWe considered risk factors before, during and after intake assessments of 3284 adults with/without suicidal acts, overall and with bipolar disorder (BD) versus major depressive disorder (MDD), using bivariate comparisons, multivariable regression modelling and receiver operating characteristic (ROC) analysis.ResultsSuicidal prevalence was greater in BD versus MDD: ideation, 29.2 versus 17.3%; attempts, 18.8 versus 4.78%; suicide, 1.73 versus 0.48%; attempts/suicide ratio indicated similar lethality, 10.9 versus 9.96. Suicidal acts were associated with familial BD or suicide, being divorced/unmarried, fewer children, early abuse/trauma, unemployment, younger onset, longer illness, more dysthymic or cyclothymic temperament, attention-deficit hyperactivity disorder (ADHD), substance misuse, mixed features, hospital admission, percentage time unwell, less antidepressants and more antipsychotics and mood stabilisers. Logistic regression found five independent factors: hospital admission, more depression at intake, BD diagnosis, onset age ≤25 years and mixed features. These factors were more associated with suicidal acts in BD than MDD: percentage time depressed/ill, alcohol misuse, >4 pre-intake depressions, more dysthymic/cyclothymic temperament and prior abuse/trauma. ADHD and total years ill were similar in BD and MDD; other factors were more associated with MDD. By ROC analysis, area under the curve was 71.3%, with optimal sensitivity (76%) and specificity (55%) with any two factors.ConclusionsSuicidal risks were high in mood disorders: ideation was highest with BD type II, attempts and suicides (especially violent) with BD type I. Several risk factors for suicidal acts differed between BD versus MDD patients.Declaration of interestNo author or immediate family member has financial relationships with commercial entities that might appear to represent potential conflicts of interest with the information presented.

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“…Consistently, previous research has demonstrated that patients experiencing mixed depressive episodes are significantly more likely to have suicidal ideation and suicidal behavior, 10,26,35 poor concentration, 11,14,19 poor appetite, 11 and insomnia. 2,7,10 Intriguingly, these symptoms are also typical symptoms of a mixed manic episode. 23,28,36 Previous literature is not consistent regarding the association that we found between concurrent agitated and slowed activity.…”

Section: Discussionmentioning

confidence: 98%

“…When the prevalence of AD has been compared between unipolar depressive disorder and bipolar disorder the results have systematically highlighted a higher prevalence of AD in bipolar disorder 2. When the prevalence of AD has been compared between unipolar depressive disorder and bipolar disorder the results have systematically highlighted a higher prevalence of AD in bipolar disorder 2.…”

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confidence: 94%

“…8,13,27 Undetected AD could result in inappropriate treatment, 10,14,24 often with dangerous outcomes. 2,28 In particular, it has been shown that antidepressant therapy in AD increases both psychomotor agitation 16,29 and other concurrent excitatory symptoms, 30 and as a most serious consequence, antidepressants increase the risk of suicide in AD. 9,10,23,29,31,32 A further in-depth investigation of the prevalence and clinical correlates of AD in a large and representative sample of individuals with bipolar disorder would have clinical utility for the recognition of this serious form of depression in bipolar disorder.…”

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Agitated depression in bipolar disorder

et al. 2019

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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.

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Mixed symptoms in major depressive and bipolar disorders: A systematic review

Cited by 51 publications

References 48 publications

Antisuicidal Effects in Mood Disorders: Are They Unique to Lithium?

Antisuicidal Effects in Mood Disorders: Are They Unique to Lithium?

Suicidal risk factors in major affective disorders

Agitated depression in bipolar disorder

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