Is recurrence in major depressive disorder related to bipolarity and mixed features? Results from the BRIDGE-II-Mix study

Lorenzo Mazzarini; Georgios D Kotzalidis; Daria Piacentino; Salvatore Rizzato; Jules Angst; Jean-Michel Azorin; Charles L Bowden; Sergey Mosolov; Allan H Young; Eduard Vieta; Paolo Girardi; Giulio Perugi; BRIDGE-II-Mix Study Group

doi:10.1016/j.jad.2017.12.062

Is recurrence in major depressive disorder related to bipolarity and mixed features? Results from the BRIDGE-II-Mix study

J Affect Disord. 2018 Mar 15:229:164-170. doi: 10.1016/j.jad.2017.12.062. Epub 2018 Jan 2.

Affiliations

¹ NESMOS Department, School of Medicine and Psychology, Sapienza University, Rome, Italy; Salvator Mundi International Hospital, Rome, Italy.
² NESMOS Department, School of Medicine and Psychology, Sapienza University, Rome, Italy.
³ NESMOS Department, School of Medicine and Psychology, Sapienza University, Rome, Italy; Salvator Mundi International Hospital, Rome, Italy; Psychiatric Hospital, University of Zurich, Switzerland; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France; Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia; Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Bipolar Disorders Unit, Clinical Institute of Neuroscience, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Catalonia, Spain; Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
⁴ AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France.
⁵ Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
⁶ Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia.
⁷ Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁸ Bipolar Disorders Unit, Clinical Institute of Neuroscience, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Catalonia, Spain.
⁹ Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy. Electronic address: giulio.perugi@med.unipi.it.

PMID: 29310066
DOI: 10.1016/j.jad.2017.12.062

Abstract

Background: Current classifications separate Bipolar (BD) from Major Depressive Disorder (MDD) based on polarity rather than recurrence. We aimed to determine bipolar/mixed feature frequency in a large MDD multinational sample with (High-Rec) and without (Low-Rec) >3 recurrences, comparing the two subsamples.

Methods: We measured frequency of bipolarity/hypomanic features during current depressive episodes (MDEs) in 2347 MDD patients from the BRIDGE-II-mix database, comparing High-Rec with Low-Rec. We used Bonferroni-corrected Student's t-test for continuous, and chi-squared test, for categorical variables. Logistic regression estimated the size of the association between clinical characteristics and High-Rec MDD.

Results: Compared to Low-Rec (n = 1084, 46.2%), High-Rec patients (n = 1263, 53.8%) were older, with earlier depressive onset, had more family history of BD, more atypical features, suicide attempts, hospitalisations, and treatment resistance and (hypo)manic switches when treated with antidepressants, higher comorbidity with borderline personality disorder, and more hypomanic symptoms during current MDE, resulting in higher rates of mixed depression according to both DSM-5 and research-based diagnostic (RBDC) criteria. Logistic regression showed age at first symptoms < 30 years, current MDE duration ≤ 1 month, hypomania/mania among first-degree relatives, past suicide attempts, treatment-resistance, antidepressant-induced swings, and atypical, mixed, or psychotic features during MDE to associate with High-Rec.

Limitations: Number of MDEs for defining recurrence was arbitrary; cross-sectionality did not allow assessment of conversion from MDD to BD.

Conclusions: High-Rec MDD differed from Low-Rec group for several clinical/epidemiological variables, including bipolar/mixed features. Bipolarity specifier and RBDC were more sensitive than DSM-5 criteria in detecting bipolar and mixed features in MDD.

Keywords: Cyclicity; Major depressive disorder; Mixed features; Recurrence.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Bipolar Disorder / diagnosis*
Bipolar Disorder / epidemiology
Bipolar Disorder / psychology*
Comorbidity
Cross-Sectional Studies
Depressive Disorder, Major / diagnosis*
Depressive Disorder, Major / epidemiology
Depressive Disorder, Major / psychology*
Female
Humans
Logistic Models
Male
Middle Aged
Psychiatric Status Rating Scales
Recurrence
Retrospective Studies
Young Adult