Sub-threshold bipolar disorder in medication-free young subjects with major depression: Clinical characteristics and antidepressant treatment response

• Published in: Journal of psychiatric research 2019-03, Vol.110, p.1-8
• Main Authors: Koirala, Parashar, Hu, Bo, Altinay, Murat, Li, Manshi, DiVita, Amy L., Bryant, Kelly A., Karne, Harish S., Fiedorowicz, Jess G., Anand, Amit
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Alcoholism - epidemiology; Antidepressant treatment; Antidepressive Agents - pharmacology; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - epidemiology; Bipolar Disorder - physiopathology; Borderline Personality Disorder - epidemiology; Comorbidity; Depression; Depressive Disorder - epidemiology; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - physiopathology; Disease Progression; Female; Humans; Hypomania; Longitudinal Studies; Male; Mania; Outcome Assessment, Health Care; Risk; Subthreshold symptoms; Young Adult; Young-adults; Youth
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2018.12.006

This study, for the first time, compared illness and antidepressant response characteristics of young subjects with major depression (MDD) at low (LRMDD) or high-risk (HRMDD) for developing bipolar disorder with characteristics of young bipolar (BPD) subjects and healthy controls (HC). One hundred and six young (15–30 yr), medication-free subjects MDD subjects (HRMDD, N = 51; LRMDD, N = 55) were compared with 32 BPD (Type I: 14; Type II: 18) as well as 49 HC subjects. Baseline illness characteristics and frequency of comorbid conditions were examined using Analysis of Variance and Cochran-Armitage trend test. Additionally, in MDD subjects, the effect of open-label antidepressant treatment for up to 24 months with periodic assessments was compared between HRMDD and LRMDD groups for treatment response, remission and (hypo)mania switch while controlling for attrition. Significant gradation from LRMDD to HRMDD to BPD groups was found for increasing occurrence of alcohol dependence (p = 0.006), comorbid PTSD (p = 0.006), borderline personality traits (p = 0.001), and occurrence of melancholic features (p 25% increase in YMRS scores)(p = 0.04). Findings of the study indicate that a substantial proportion of young MDD subjects share BPD illness characteristics. These HRMDD subjects, if treated with antidepressants, need to be monitored for development of BPD. NCT01811147.