Hypomanic symptoms in major depressive disorder: Prognostic impact and treatment issues. in Journal of affective disorders / J Affect Disord. 2025 Jan 15;369:1021-1030. doi: 10.1016/j.jad.2024.10.104. Epub 2024 Oct 22.

2025
ASL Torino 4

Tipo pubblicazione

Journal Article

Autori/Collaboratori (15)Vedi tutti...

Olgiati P
Department of Sciences of Public Health and Paediatrics, University of Turin, Turin, Italy; Department of Psychiatry ASLTO4, Turin, Italy.
Kasper S
Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria; Center for Brain Research, Department of Molecular Neuroscience, Medical University Vienna, Vienna, Austria.
Zohar J
Department of Psychiatry, Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Israel.

et alii...

Abstract

BACKGROUND: Mixed depression (MXD), defined as (hypo)manic symptoms occurring within major depressive episodes, is common in both bipolar and unipolar disorders, but its prognostic and treatment implications remain unclear. This study aimed to examine the relationship between hypomanic symptoms, treatment response and remission of suicidal thoughts. METHODS: We analyzed 1243 adults with major depressive disorder (MDD), recruited for a naturalistic study on treatment-resistant depression. Data were gathered cross-sectionally and retrospectively through structured interviews and clinical rating scales including the Young Mania Rating Scale (YMRS) and Montgomery-Asberg Depression Rating Scale (MADRS); statistical analyses were performed using univariate and multivariate methods. RESULTS: Hypomanic symptoms were present in 651 patients (45 %), while 307 patients (25 %) responded to treatment. Both treatment responders (p < 0.0001) and those who achieved remission from suicide ideation (p = 0.0085) showed lower hypomanic (YMRS) scores. Multivariate analysis showed that hypomanic symptoms were negatively linked to treatment response (O.R. 0.71-0.87), while bipolar spectrum markers such as age at illness onset (O.R. 1.00-1.03) and MDD recurrence (O.R. 0.47-0.89) predicted remission from suicidal thoughts. Medications commonly used to treat bipolar disorder showed some benefits, with dopamine/serotonin antagonists improving suicide ideation (p < 0.0001) and mood stabilizers being associated with reduced hypomanic symptoms (p = 0.0003). LIMITATIONS: The study lacked prospective clinical assessments and treatment randomization. CONCLUSION: Hypomanic symptoms are common in unipolar depression; their assessment is essential to identify challenging-to-treat cases and select the best pharmacological options.

Accesso banca dati bibliografica

PMID : 39447979

DOI : 10.1016/j.jad.2024.10.104

Keywords

Humans; Depressive Disorder, Major/drug therapy; Female; Male; Adult; Middle Aged; Suicidal Ideation; Prognosis; Retrospective Studies; Cross-Sectional Studies; Mania/drug therapy; Psychiatric Status Rating Scales; Antidepressive Agents/therapeutic use; Depressive Disorder, Treatment-Resistant/drug therapy; Bipolar Disorder/drug therapy/diagnosis; Treatment Outcome; Antidepressant response; Hypomanic symptoms; Major depressive disorder; Mood stabilizers; Treatment-resistant depression; Unipolar depression;