Sub-threshold bipolar disorder in medication-free young subjects with major depression: Clinical characteristics and antidepressant treatment response

Parashar Koirala; Bo Hu; Murat Altinay; Manshi Li; Amy L DiVita; Kelly A Bryant; Harish S Karne; Jess G Fiedorowicz; Amit Anand

doi:10.1016/j.jpsychires.2018.12.006

Back

Sub-threshold bipolar disorder in medication-free young subjects with major depression: Clinical characteristics and antidepressant treatment response

Journal article

Peer reviewed

Sub-threshold bipolar disorder in medication-free young subjects with major depression: Clinical characteristics and antidepressant treatment response

Parashar Koirala, Bo Hu, Murat Altinay, Manshi Li, Amy L DiVita, Kelly A Bryant, Harish S Karne, Jess G Fiedorowicz and Amit Anand

Journal of psychiatric research, Vol.110, pp.1-8

03/2019

DOI: 10.1016/j.jpsychires.2018.12.006

PMID: 30579045

View Online

Abstract

This study, for the first time, compared illness and antidepressant response characteristics of young subjects with major depression (MDD) at low (LRMDD) or high-risk (HRMDD) for developing bipolar disorder with characteristics of young bipolar (BPD) subjects and healthy controls (HC). One hundred and six young (15–30 yr), medication-free subjects MDD subjects (HRMDD, N = 51; LRMDD, N = 55) were compared with 32 BPD (Type I: 14; Type II: 18) as well as 49 HC subjects. Baseline illness characteristics and frequency of comorbid conditions were examined using Analysis of Variance and Cochran-Armitage trend test. Additionally, in MDD subjects, the effect of open-label antidepressant treatment for up to 24 months with periodic assessments was compared between HRMDD and LRMDD groups for treatment response, remission and (hypo)mania switch while controlling for attrition. Significant gradation from LRMDD to HRMDD to BPD groups was found for increasing occurrence of alcohol dependence (p = 0.006), comorbid PTSD (p = 0.006), borderline personality traits (p = 0.001), and occurrence of melancholic features (p < 0.005). Antidepressant treatment response was similar between the two groups except that for the 12-month period HRMDD showed a trend for a lower response. Switch to (hypo)mania was infrequent in both groups though the HRMDD showed a higher occurrence of spikes in (hypo)mania symptoms (>25% increase in YMRS scores)(p = 0.04). Findings of the study indicate that a substantial proportion of young MDD subjects share BPD illness characteristics. These HRMDD subjects, if treated with antidepressants, need to be monitored for development of BPD. NCT01811147.

Mania

Bipolar disorder

Depression

Youth

Antidepressant treatment

Hypomania

Young-adults

Subthreshold symptoms

Details

Title: Subtitle: Sub-threshold bipolar disorder in medication-free young subjects with major depression: Clinical characteristics and antidepressant treatment response
Creators: Parashar Koirala - Center for Behavioral Health, Cleveland Clinic, USA
Bo Hu - Quantitative Health Sciences Center, Cleveland Clinic, USA
Murat Altinay - Center for Behavioral Health, Cleveland Clinic, USA
Manshi Li - Quantitative Health Sciences Center, Cleveland Clinic, USA
Amy L DiVita - Center for Behavioral Health, Cleveland Clinic, USA
Kelly A Bryant - Center for Behavioral Health, Cleveland Clinic, USA
Harish S Karne - Center for Behavioral Health, Cleveland Clinic, USA
Jess G Fiedorowicz - Departments of Psychiatry, Epidemiology, and Internal Medicine, University of Iowa, USA
Amit Anand - Center for Behavioral Health, Cleveland Clinic, USA
Resource Type: Journal article
Publication Details: Journal of psychiatric research, Vol.110, pp.1-8
Publisher: Elsevier Ltd
DOI: 10.1016/j.jpsychires.2018.12.006
PMID: 30579045
ISSN: 0022-3956
eISSN: 1879-1379
Grant note: DOI: 10.13039/100000025, name: NIMH, award: R01MH093420
Language: English
Date published: 03/2019
Academic Unit: Psychiatry; Anatomy and Cell Biology; Epidemiology; Iowa Neuroscience Institute
Record Identifier: 9984065391102771

Metrics

22 Record Views

12 Times Cited - Web of Science