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Proposed DSM-5 mixed features are associated with greater likelihood of remission in out-patients with major depressive disorder

Published online by Cambridge University Press:  15 March 2012

R. H. Perlis ,
C. Cusin  and
M. Fava
R. H. Perlis*
Affiliation:
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
C. Cusin
Affiliation:
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
M. Fava
Affiliation:
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: R. H. Perlis, M.D., Massachusetts General Hospital, Center for Experimental Drugs and Diagnostics, 185 Cambridge Street, Boston, MA 02114, USA. (Email: [email protected])
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Abstract

Background

Draft DSM-5 criteria for a mixed major depressive episode have been proposed, but their predictive validity has not yet been established. We hypothesized that such symptoms would be associated with poorer antidepressant treatment outcomes.

Method

We examined outcomes among individuals with major depressive disorder participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, an effectiveness study conducted at primary and specialty care centers in the USA. Mixed features were derived from the six self-report items of the mania subscale of the Psychiatric Diagnosis Screening Questionnaire. Primary analyses examined the association between the presence of at least two of these in the 6 months before study entry, and remission across up to four sequential treatment trials, as well as adverse outcomes.

Results

Of the 2397 subjects with a major depressive episode of at least 6 months' duration, 449 (18.7%) reported at least two mixed symptoms. The presence of such symptoms was associated with a greater likelihood of remission across up to four sequential treatments, which persisted after adjustment for potential confounding clinical and demographic variables (adjusted hazard ratio 1.16, 95% confidence interval 1.03–1.28). Two individual items, expansive mood and cheerfulness, were strongly associated with a greater likelihood of remission.

Conclusions

Proposed DSM-5 mixed state features were associated with a greater rather than a lesser likelihood of remission. While unexpected, this result suggests the potential utility of further investigation of depressive mixed states in major depression.

Keywords

Bipolar disorderbipolar spectrumcitalopramDSM-5major depressive disordermixed stateselective serotonin reuptake inhibitorstreatment-resistant depression
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 7 , May 2014 , pp. 1361 - 1367
Copyright
Copyright © Cambridge University Press 2012 

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References

Angst, J, Azorin, JM, Bowden, CL, Perugi, G, Vieta, E, Gamma, A, Young, AH (2011). Prevalence and characteristics of undiagnosed bipolar disorders in patients with a major depressive episode: the BRIDGE study. Archives of General Psychiatry 68, 791–798.CrossRefGoogle Scholar
Anon. (2011). DSM-V Proposed Revision: Mixed Features Modifier (http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=483).Google Scholar
Benazzi, F, Koukopoulos, A, Akiskal, HS (2004). Toward a validation of a new definition of agitated depression as a bipolar mixed state (mixed depression). European Psychiatry 19, 85–90.Google Scholar
Fava, M (2003). Diagnosis and definition of treatment-resistant depression. Biological Psychiatry 53, 649–659.Google Scholar
Fava, M, Rush, AJ, Trivedi, MH, Nierenberg, AA, Thase, ME, Sackeim, HA, Quitkin, FM, Wisniewski, S, Lavori, PW, Rosenbaum, JF, Kupfer, DJ (2003). Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatric Clinics of North America 26, 457–494, x.Google Scholar
Ghaemi, SN, Ko, JY, Goodwin, FK (2001). The bipolar spectrum and the antidepressant view of the world. Journal of Psychiatric Practice 7, 287–297.CrossRefGoogle ScholarPubMed
Goldberg, JF, Perlis, RH, Bowden, CL, Thase, ME, Miklowitz, DJ, Marangell, LB, Calabrese, JR, Nierenberg, AA, Sachs, GS (2009). Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD. American Journal of Psychiatry 166, 173–181.CrossRefGoogle Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.Google Scholar
Koukopoulos, A, Sani, G, Koukopoulos, AE, Manfredi, G, Pacchiarotti, I, Girardi, P (2007). Melancholia agitata and mixed depression. Acta Psychiatrica Scandinavica Supplementum 433, 50–57.CrossRefGoogle Scholar
Moreno, DH, Andrade, LH (2010). Latent class analysis of manic and depressive symptoms in a population-based sample in Sao Paulo, Brazil. Journal of Affective Disorders 123, 208–215.CrossRefGoogle Scholar
Perlis, RH, Uher, R, Ostacher, M, Goldberg, JF, Trivedi, MH, Rush, AJ, Fava, M (2011). Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder. Archives of General Psychiatry 68, 351–360.Google Scholar
Rush, AJ, Fava, M, Wisniewski, SR, Lavori, PW, Trivedi, MH, Sackeim, HA, Thase, ME, Nierenberg, AA, Quitkin, FM, Kashner, TM, Kupfer, DJ, Rosenbaum, JF, Alpert, J, Stewart, JW, McGrath, PJ, Biggs, MM, Shores-Wilson, K, Lebowitz, B, Ritz, L, Niederehe, G (2004). Sequenced Treatment Alternatives to Relieve Depression (STAR*D): rationale and design. Controlled Clinical Trials 25, 119–142.Google Scholar
Rush, AJ, Trivedi, MH, Wisniewski, SR, Nierenberg, AA, Stewart, JW, Warden, D, Niederehe, G, Thase, ME, Lavori, PW, Lebowitz, BD, McGrath, PJ, Rosenbaum, JF, Sackeim, HA, Kupfer, DJ, Luther, J, Fava, M (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. American Journal of Psychiatry 163, 1905–1917.CrossRefGoogle ScholarPubMed
Salvatore, P, Baldessarini, RJ, Centorrino, F, Egli, S, Albert, M, Gerhard, A, Maggini, C (2002). Weygandt's On the Mixed States of Manic-Depressive Insanity: a translation and commentary on its significance in the evolution of the concept of bipolar disorder. Harvard Review of Psychiatry 10, 255–275.Google Scholar
Sato, T, Bottlender, R, Schroter, A, Moller, HJ (2003). Frequency of manic symptoms during a depressive episode and unipolar ‘depressive mixed state’ as bipolar spectrum. Acta Psychiatrica Scandinavica Supplementum 107, 268–274.Google Scholar
Simon, NM, Otto, MW, Wisniewski, SR, Fossey, M, Sagduyu, K, Frank, E, Sachs, GS, Nierenberg, AA, Thase, ME, Pollack, MH (2004). Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). American Journal of Psychiatry 161, 2222–2229.Google Scholar
Simon, NM, Smoller, JW, Fava, M, Sachs, G, Racette, SR, Perlis, R, Sonawalla, S, Rosenbaum, JF (2003). Comparing anxiety disorders and anxiety-related traits in bipolar disorder and unipolar depression. Journal of Psychiatric Research 37, 187–192.Google Scholar
Suppes, T, Mintz, J, McElroy, SL, Altshuler, LL, Kupka, RW, Frye, MA, Keck, PE Jr., Nolen, WA, Leverich, GS, Grunze, H, Rush, AJ, Post, RM (2005). Mixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Network: a sex-specific phenomenon. Archives of General Psychiatry 62, 1089–1096.CrossRefGoogle ScholarPubMed
Swann, AC, Moeller, FG, Steinberg, JL, Schneider, L, Barratt, ES, Dougherty, DM (2007). Manic symptoms and impulsivity during bipolar depressive episodes. Bipolar Disorders 9, 206–212.Google Scholar
Zimmerman, M, Galione, JN, Chelminski, I, Young, D, Ruggero, CJ (2010). Performance of the Bipolar Spectrum Diagnostic Scale in psychiatric outpatients. Bipolar Disorders 12, 528–538.Google Scholar
Zimmerman, M, Mattia, JI (2001 a). The Psychiatric Diagnostic Screening Questionnaire: development, reliability and validity. Comprehensive Psychiatry 42, 175–189.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (2001 b). A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire. Archives of General Psychiatry 58, 787–794.Google Scholar