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Born C, Grunze H, Post RM, et al. Mania and bipolar depression: complementing not opposing poles-a post-hoc analysis of mixed features in manic and hypomanic episodes. Int J Bipolar Disord. 2021;9(1):36doi: 10.1186/s40345-021-00241-5.
Born, C., Grunze, H., Post, R. M., Altshuler, L. L., Kupka, R., McElroy, S. L., Frye, M. A., Suppes, T., Keck, P. E., Nolen, W. A., & Schaerer, L. (2021). Mania and bipolar depression: complementing not opposing poles-a post-hoc analysis of mixed features in manic and hypomanic episodes. International journal of bipolar disorders, 9(1), 36. https://doi.org/10.1186/s40345-021-00241-5
Born, Christoph, et al. "Mania and bipolar depression: complementing not opposing poles-a post-hoc analysis of mixed features in manic and hypomanic episodes." International journal of bipolar disorders vol. 9,1 (2021): 36. doi: https://doi.org/10.1186/s40345-021-00241-5
Born C, Grunze H, Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Suppes T, Keck PE, Nolen WA, Schaerer L. Mania and bipolar depression: complementing not opposing poles-a post-hoc analysis of mixed features in manic and hypomanic episodes. Int J Bipolar Disord. 2021 Nov 16;9(1):36. doi: 10.1186/s40345-021-00241-5. PMID: 34782957; PMCID: PMC8593087.
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Int J Bipolar Disord. 2021 Nov 16;9(1):36. doi: 10.1186/s40345-021-00241-5.

Mania and bipolar depression: complementing not opposing poles-a post-hoc analysis of mixed features in manic and hypomanic episodes.

International journal of bipolar disorders

Christoph Born, Heinz Grunze, Robert M Post, Lori L Altshuler, Ralph Kupka, Susan L McElroy, Mark A Frye, Trisha Suppes, Paul E Keck, Willem A Nolen, Lars Schaerer

Affiliations

  1. Paracelsus Medical University, Nuremberg, Germany.
  2. Psychiatrie Schwäbisch Hall, Ringstrasse 1, 74523, Schwäbisch Hall, Germany.
  3. Paracelsus Medical University, Nuremberg, Germany. [email protected].
  4. Psychiatrie Schwäbisch Hall, Ringstrasse 1, 74523, Schwäbisch Hall, Germany. [email protected].
  5. Bipolar Collaborative Network, Bethesda, MD, USA.
  6. Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA.
  7. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
  8. Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, Los Angeles, CA, USA.
  9. Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
  10. Lindner Center of HOPE, Mason, OH, USA.
  11. Biological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH, USA.
  12. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
  13. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
  14. V.A. Palo Alto Health Care System, Palo Alto, CA, USA.
  15. Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
  16. Department of Psychiatry and Psychotherapy Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.

PMID: 34782957 PMCID: PMC8593087 DOI: 10.1186/s40345-021-00241-5

Abstract

BACKGROUND: Depending on the classification system used, 5-40% of manic subjects present with concomitant depressive symptoms. This post-hoc analysis evaluates the hypothesis that (hypo)manic subjects have a higher burden of depression than non-(hypo)manic subjects.

METHODS: Data from 806 Bipolar I or II participants of the Stanley Foundation Bipolar Network (SFBN) were analyzed, comprising 17,937 visits. A split data approach was used to separate evaluation and verification in independent samples. For verification of our hypotheses, we compared mean IDS-C scores ratings of non-manic, hypomanic and manic patients. Data were stored on an SQL-server and extracted using standard SQL functions. Linear correlation coefficients and pivotal tables were used to characterize patient groups.

RESULTS: Mean age of participants was 40 ± 12 years (range 18-81). 460 patients (57.1%) were female and 624 were diagnosed as having bipolar I disorder (77.4%) and 182 with bipolar II (22.6%). Data of 17,937 visits were available for analyses, split into odd and even patient numbers and stratified into three groups by YMRS-scores: not manic < 12, hypomanic < 21, manic < 30. Average IDS-C sum scores in manic or hypomanic states were significantly higher (p < .001) than for non-manic states. (Hypo)manic female patients were likely to show more depressive symptoms than males (p < .001). Similar results were obtained when only the core items of the YMRS or only the number of depressive symptoms were considered. Analyzing the frequency of (hypo)manic mixed states applying a proxy of the DSM-5 mixed features specifier extracted from the IDS-C, we found that almost 50% of the (hypo)manic group visits fulfilled DSM-5 mixed features specifier criteria.

CONCLUSION: Subjects with a higher manic symptom load are also significantly more likely to experience a higher number of depressive symptoms. Mania and depression are not opposing poles of bipolarity but complement each other.

© 2021. The Author(s).

Keywords: Bipolar disorder; Depression; Hypomania; Mania; Mixed states

References

  1. Psychiatry Res. 1986 May;18(1):65-87 - PubMed
  2. Compr Psychiatry. 2000 Mar-Apr;41(2):77-82 - PubMed
  3. J Affect Disord. 2001 Dec;67(1-3):229-40 - PubMed
  4. Arch Gen Psychiatry. 2005 Oct;62(10):1089-96 - PubMed
  5. Int J Bipolar Disord. 2017 Nov 6;5(1):36 - PubMed
  6. Br J Psychiatry. 1978 Nov;133:429-35 - PubMed
  7. J Clin Psychiatry. 2011 May;72(5):671-6 - PubMed
  8. J Affect Disord. 2014 Mar;156:206-13 - PubMed
  9. Arch Gen Psychiatry. 2006 Feb;63(2):175-83 - PubMed
  10. J Affect Disord. 2006 Dec;96(3):225-32 - PubMed
  11. Clin Neuropharmacol. 1992;15 Suppl 1 Pt A:632A-633A - PubMed
  12. J Affect Disord. 2001 Dec;67(1-3):33-44 - PubMed
  13. J Affect Disord. 2018 Jan 15;226:239-244 - PubMed
  14. Psychol Med. 2019 May;49(7):1102-1108 - PubMed
  15. BMC Psychiatry. 2014 May 07;14:130 - PubMed
  16. J Affect Disord. 2000 Sep;59 Suppl 1:S5-S30 - PubMed
  17. Eur Neuropsychopharmacol. 2015 Nov;25(11):1882-91 - PubMed
  18. Aust N Z J Psychiatry. 2015 Jun;49(6):540-9 - PubMed
  19. Psychol Med. 1996 May;26(3):477-86 - PubMed
  20. J Psychiatr Res. 1997 Sep-Oct;31(5):593-603 - PubMed
  21. J Affect Disord. 2007;100 Suppl 1:S45-53 - PubMed
  22. World J Biol Psychiatry. 2018 Feb;19(1):2-58 - PubMed
  23. Bipolar Disord. 2008 Feb;10(1 Pt 2):144-52 - PubMed
  24. J Affect Disord. 2013 Sep 5;150(2):378-83 - PubMed
  25. J Affect Disord. 2013 May 15;148(1):28-36 - PubMed
  26. Arch Gen Psychiatry. 2004 May;61(5):459-67 - PubMed
  27. Psychopathology. 2015;48(3):192-201 - PubMed
  28. Biol Psychiatry. 2003 Jun 1;53(11):1028-42 - PubMed
  29. J Affect Disord. 2018 Mar 15;229:164-170 - PubMed
  30. Neuropsychiatr Dis Treat. 2015 Apr 29;11:1137-43 - PubMed
  31. J Clin Psychiatry. 2006 Oct;67(10):1551-60 - PubMed
  32. Am J Psychiatry. 1992 Dec;149(12):1633-44 - PubMed
  33. Acta Psychiatr Scand. 2008 Mar;117(3):216-24 - PubMed
  34. Am J Psychiatry. 2016 Oct 1;173(10):1015-1023 - PubMed

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