Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

Abstract

Objectives: BRIDGE-II-MIX study aimed to estimate the frequency of mixed states in patients with MDE according to different definitions. This post-hoc analysis evaluates the association between obesity and the presence of mixed features and bipolarity. Methods: 2811 MDE subjects were enrolled in this multicentre crosssectional study. In 2744 patients, the body mass index (BMI) has been evaluated.Psychiatric symptoms, socio-demographic and clinical variables were collected, comparing the characteristics of MDE patients with (MDE-OB) and without obesity (MDE-NOB). Results: obesity (BMI ≥30) was registered in 493 patients (18%). In the MDE-OB group, 90 patients (20%) fulfilled DSM-IV-TR criteria for BD, 225 patients (50%) fulfilled the criteria for bipolarity specifier, 59 patients (13%) fulfilled DSM-5 criteria for MDE with mixed features and 226 patients (50%) fulfilled Research-Based Diagnostic Criteria for a mixed depressive episode. Older age, history of (hypo)manic switches during antidepressant treatment, the occurrence of three or more MDEs, atypical depressive features, antipsychotic treatment, female gender, depressive mixed state according to DSM-5 criteria, comorbid eating disorders and anxiety disorders were significantly associated with MDE-OB group. Among (hypo)manic symptoms during the current MDE, psychomotor agitation, distractibility, increased energy and risky behaviors were the variables most frequently associated with MDE-OB group.Conclusions: In our sample, the presence of obesity in patients with MDE seems to be associated with a lifetime diagnosis of BD. These findings suggest that obesity in patients with MDE could be considered a possible marker of bipolarity.

Is obesity changing the phenotype of bipolar disorder from predominately euphoric toward mixed presentations?

“…Briefly, investigators post hoc analyzed data from The Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)‐II‐Mix study wherein they sought to determine whether an association exists between mixed features and bipolarity among adults with a major depressive episode (MDE). The strength of the data was the sample size (ie, n = 2744) and the representativeness of the patients who were enrolled, assessed, and evaluated by highly experienced clinicians …”

“…The strength of the data was the sample size (ie, n = 2744) and the representativeness of the patients who were enrolled, assessed, and evaluated by highly experienced clinicians. 2 The paper concluded that among adults meeting criteria for a MDE and comorbid obesity (ie, MDE-OB), 20% met criteria for bipolar disorder, 50% met criteria for the Angst bipolar specifier, and 13% for mixed features using either the DSM-5 criteria or the more encompassing (ie, including overlapping symptoms) Research-Based Diagnostic Criteria for Mixed State (RBDX-MSX). Moreover, MDE-OB individuals also were more likely to have other "bipolar probabilistic factors" (eg, higher number of prior episodes, atypical depressive features).…”

Investigating the complex relationship between bipolarity and obesity: “Not because it is easy, but because it is hard”

“…The bipolarity‐obesity relationship is complex, a fact that is increasingly appreciated thanks to high‐quality studies such as the one recently published in Bipolar Disorders by Petri and colleagues . Previously, obesity in patients with psychiatric illness was viewed primarily as a consequence of treatment with weight‐gain‐promoting medications, and given what is known about many of the agents in this regard, this view is perhaps understandable.…”

“…1 The bipolarity-obesity relationship is complex, a fact that is increasingly appreciated thanks to high-quality studies such as the one recently published in Bipolar Disorders by Petri and colleagues. 2 Previously, obesity in patients with psychiatric illness was viewed primarily as a consequence of treatment with weight-gain-promoting medications, and given what is known about many of the agents in this regard, this view is perhaps understandable. Placebo-controlled trials and clinical experience show convincingly that treatment with most mood stabilizers and second-generation antipsychotics (SGAs) and some antidepressants increases the likelihood of weight gain.…”

Can obesity in a major depressive episode be considered as a biomarker for bipolar spectrum disorders?

“…As an objective measure of obesity, body mass index (BMI) in patients with psychiatric disorders, especially in schizophrenia and BP, have attracted researchers. In the article of “Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study,” Petri and colleagues used BMI ≥30 to divide 2811 patients with a MDE into two groups, MDE‐obesity group and MDE‐non‐obesity group, to study the association between obesity and bipolarity . The bipolarity included bipolar I and II disorders based on DSM‐IV, bipolar I and II specifier based on the DSM‐IV‐TR, depressive mixed state based on DSM‐5, and mixed depression based on the research‐based diagnostic criteria (RBDC).…”