Mixed Depression in Bipolar Disorder: Prevalence Rate and Clinical Correlates During Naturalistic Follow-Up in the Stanley Bipolar Network

Shefali Miller*, Trisha Suppes, Jim Mintz, Gerhard Hellemann, Mark A. Frye, Susan L. McElroy, Willem A. Nolen, Ralph Kupka, Gabriele S. Leverich, Heinz Grunze, Lori L. Altshuler, Paul E. Keck, Robert M. Post

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

36 Citations (Scopus)

Abstract

Objective: DSM-5 introduced the "with mixed features" specifier for major depressive episodes. The authors assessed the prevalence and phenomenology of mixed depression among bipolar disorder patients and qualitatively compared a range of diagnostic thresholds for mixed depression.

Method: In a naturalistic study, 907 adult outpatients with bipolar disorder participating in the Stanley Foundation Bipolar Network were followed longitudinally across 14,310 visits from 1995 to 2002. The Inventory of Depressive Symptomatology-Clinician-Rated Version (IDS-C) and the Young Mania Rating Scale (YMRS) were administered at each visit.

Results: Mixed depression, defined as an IDS-C score >= 15 and a YMRS score >2 and = 3 non overlapping YMRS items concurrent with an IDS-C score >= 15 to broader definitions requiring >= 2 nonoverlapping YMRS items) yielded lower mixed depression prevalence rates (6.3% and 10.8% of visits, respectively) but were found to have similar relationships to gender and longitudinal symptom severity.

Conclusions: Among outpatients with bipolar disorder, concurrent hypomanic symptoms observed during visits with depression were common, particularly in women. The DSM-5 diagnostic criteria for depression with mixed features may yield inadequate sensitivity to detect patients with mixed depression.

Original languageEnglish
Pages (from-to)1015-1023
Number of pages9
JournalAmerican Journal of Psychiatry
Volume173
Issue number10
DOIs
Publication statusPublished - Oct-2016

Keywords

  • MANIC SYMPTOMS
  • AGITATED DEPRESSION
  • STATE
  • EPISODES
  • SYMPTOMATOLOGY
  • PHENOMENOLOGY
  • INVENTORY
  • DIAGNOSIS

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