Bipolar II disorder (BDII) may be confused with borderline personality disorder (BPD) when it is cyclothymic between episodes. The aim of the present study was to determine the prevalence of BPD and to test whether BDII can be distinguished from BPD without difficulty in private practice mood disorder outpatients. Private practice was chosen because it is often the first or second line of treatment of mood disorders in Italy, and many "soft" patients can be found in this setting. Among 63 consecutive unipolar and 50 bipolar II major depressive episode (MDE) outpatients interviewed with the Structured Clinical Interviews for DSM-IV axis I/II disorders (SCIDs), the prevalence of BPD was 6.1% and was significantly higher in BDII patients (12% v. 1.5%). Overall, the rate of BPD diagnosis was very low. BDII was distinguished from BPD without difficulty by DSM-IV criteria. The results suggest that there may be a subgroup of BDII patients with a relatively stable course between episodes (or at least not so unstable as to suggest a BPD diagnosis or comorbidity) and a low comorbidity with BPD, in a setting closer to community patients than university settings. The "usual" BDII patient can be distinguished from the BPD patient.

Adult↗

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Atypical depression in private practice depressed outpatients: a 203-case study.

The prevalence of DSM-IV atypical depression and comparisons between atypical and typical depression were studied in 203 consecutive unipolar and bipolar depressed outpatients presenting for treatment of depression in private practice. The prevalence of atypical depression was 31%. Of the variables investigated (unipolar/bipolar diagnosis, age at baseline/onset of first major depressive episode, gender, psychosis, comorbidity, chronicity, duration of illness, recurrence, and severity), a bipolar II diagnosis was significantly more common, the age at baseline and duration of illness were significantly lower, and the proportion of females and psychiatric comorbidity were significantly higher in atypical versus typical depression. Secondary analysis showed that bipolar II atypical depression had a significantly earlier age at baseline/onset and affected more females, but there were no other significant differences versus typical depression. The findings suggest important clinical differences between atypical and typical depression, and a bipolar II subtype may be separated from the broad category of atypical depression.

Ambulatory Care↗

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Bipolar II versus unipolar chronic depression: a 312-case study.

Differences between bipolar II depression and unipolar depression have been reported, such as a lower age at onset and more atypical features in bipolar II depression. The aim of the present study was to compare chronic/nonchronic bipolar II depression with chronic/nonchronic unipolar depression to determine whether the reported differences are present when chronicity is taken into account. Three hundred twelve outpatients in a bipolar II/unipolar major depressive episode were assessed with the Structured Clinical Interview for DSM-IV-Clinician Version (SCID-CV), the Montgomery and Asberg Depression Rating Scale (MADRS), and the Global Assessment of Functioning (GAF) Scale. No significant difference was found between chronic bipolar II and chronic unipolar depression (age at intake and onset, gender, duration of illness, recurrences, psychosis, atypical features, axis I comorbidity, and severity). A significantly lower age at onset and more atypical features were observed when comparing chronic/nonchronic bipolar II with nonchronic unipolar depression. These findings suggest that differences reported between bipolar II and unipolar depression are mainly due to nonchronic unipolar depression. Chronic unipolar depression may be a subtype intermediate between bipolar II depression and nonchronic unipolar depression.

Adult↗

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Major depressive episodes with hypomanic symptoms are common among depressed outpatients.

Depressive mixed states (major depressive episodes [MDE] with some hypomanic symptoms) are not classified in DSM-IV. The aim of the present study was to determine the prevalence of depressive mixed states in depressed outpatients, and to compare bipolar II with unipolar depressive mixed states. Seventy consecutive bipolar II and unipolar depressed outpatients were interviewed using the DSM-IV Structured Clinical Interview (SCID). At least one hypomanic symptom was present in 90% of patients, and three or more in 28.5%. Symptoms of depressive mixed states included irritable mood, distractibility, racing thoughts, and increased talking. Bipolar II subjects had more concurrent hypomanic symptoms (three or more in 48.7% v 3.2%, P = 0.000). Depressive mixed states with three or more hypomanic symptoms correctly classified 70.0% of bipolar II subjects. These findings have important treatment implications, as antidepressants may worsen the symptoms of depressive mixed states, and mood stabilizers can be useful.

Adult↗

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Sensitivity and specificity of clinical markers for the diagnosis of bipolar II disorder.

Bipolar II disorder is common in depressed outpatients, but the diagnosis may have low reliability because it is often based on history of hypomania. The aim of the present study was to test sensitivity and specificity for bipolar II diagnosis of some reported markers of bipolar II: atypical features, depressive mixed state, young age at onset, recurrences, and interpersonal rejection sensitivity. A total of 161 consecutive unipolar (n = 64) and bipolar II (n = 97) outpatients with major depressive episode (MDE) were interviewed using the Structured Clinical Interview for DSM-IV (SCID). Depressive mixed state was defined as a MDE with two or more (DMX2) or with three or more (DMX3) concurrent hypomanic symptoms. DMX3 and atypical features had the highest specificity (92.1% and 82.8%, respectively) and predictive power (0.69 and 0.64), but low sensitivity (46.3%, 45.3%). Concurrent presence of DMX3 and atypical features increased sensitivity (67.0%), reduced specificity (76.5%), and increased predictive power (0.75). Age at onset, recurrences, and interpersonal rejection sensitivity, concurrent with DMX3 and atypical features, increased the predictive power only slightly. Thus, two cross-sectional features of a MDE, such as DMX3 and atypical symptoms, alone or in combination, may strongly support bipolar II diagnosis, and it appears that DMX3 is the best of the two. The low reliability of bipolar II diagnosis based on history of hypomania may be improved by two cross-sectional clinical markers.

Adult↗

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Weight gain in depression remitted with antidepressants: pharmacological or recovery effect?

BACKGROUND: Depression remission is often associated with weight gain. It is not clear if weight gain is caused by a pharmacological effect of antidepressants, or if instead it is an effect of recovery from depression. The aim of this study was to try to clarify this point. METHODS: One hundred consecutive unipolar/bipolar remitted depressed private practice outpatients (DSM-IV diagnoses with structured interview) were interviewed with structured questions about weight changes occurring during depression and remission. Comparisons were made between remitted weight gainers and remitted nonweight gainers. RESULTS: Seventy-two percent of patients showed weight gain when they remitted from depression, in comparison with their weight when they were depressed. No significant differences were found in age, gender, diagnoses, duration of remission, use of tricyclics, tricyclic-SSRI combination, benzodiazepines, neuroleptics, and mood stabilizers in remitted weight gainers versus nonweight gainers. SSRIs were significantly more used in remitted nonweight gainers. Significantly more weight loss and less weight gain when depressed were found in remitted weight gainers versus nonweight gainers. CONCLUSIONS: These findings suggest that weight gain in remitted depressed patients may not necessarily be a pharmacological effect of antidepressants, but may rather be an effect, at least in part, of recovery from depression.

Adult↗

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Female depression before and after menopause.

BACKGROUND: There is no clear association between menopause and depression. Aim of the study was to compare female depression with onset before menopause with female depression with onset after menopause, to find out if endocrinological changes had an impact on depression. METHODS: Five hundred and twelve consecutive unipolar and bipolar I/II depressed outpatients were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery-Asberg Depression Rating Scale and the Global Assessment of Functioning scale. Patients were divided into patients with depression/mania onset before 40 and after 40. RESULTS: Female depression with onset after 40 had a significantly shorter duration of illness, fewer recurrences, fewer patients with atypical features, fewer bipolar II patients and more unipolar patients than female depression with onset before 40. Male depression with onset after 40 had a significantly shorter duration of illness and fewer patients with atypical features than male depression with onset before 40. CONCLUSIONS: Some features were common to both female and male depression with onset after 40. Female depression with onset after 40 had significantly more unipolar and fewer bipolar II patients, than female depression with onset before 40. Different frequency of unipolar and bipolar II patients suggests that the biology of depression in menopause women may be different from that of women not in menopause, and from that of male depression with onset after 40. Differences may be related to menopause.

Age Factors↗

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Atypical bipolar II depression compared with atypical unipolar depression and nonatypical bipolar II depression.

Aim of the study was to find out whether atypical bipolar II depression was distinct from both atypical unipolar depression and nonatypical bipolar II depression. Seventy-nine consecutive atypical bipolar II depressed outpatients were compared with 42 consecutive atypical unipolar depressed outpatients and with 53 consecutive nonatypical bipolar II depressed outpatients. Among the variables studied (age at intake, age at onset, female gender, duration of illness, psychosis, comorbidity, chronicity, recurrences, severity), age at intake and onset were significantly lower in the atypical bipolar II group than in the other groups. The other variables, apart from psychosis, were not significantly different. Findings suggest that atypical bipolar II depression may have an age at onset different from that of atypical unipolar depression and nonatypical bipolar II depression. As different ages at onset may identify distinct subtypes of depression, this finding might suggest that atypical bipolar II depression may be distinct from both atypical unipolar depression and nonatypical bipolar II depression.

Adult↗