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Sub‐threshold manic symptoms in recurrent major depressive disorder are a marker for poor outcome
Author(s) -
Smith D. J.,
Forty L.,
Russell E.,
Caesar S.,
Walters J.,
Cooper C.,
Jones I.,
Jones L.,
Craddock N.
Publication year - 2009
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/j.1600-0447.2008.01324.x
Subject(s) - bipolar disorder , major depressive disorder , family history , psychiatry , medicine , psychosis , depression (economics) , depressive symptoms , psychology , lithium (medication) , mood , anxiety , economics , macroeconomics
Objective: A small but significant proportion of patients with major depressive disorder (MDD) report mild manic symptoms which are below the diagnostic threshold for a hypomanic episode. Method: We tested for an association between sub‐threshold manic symptoms and clinical outcome in almost 600 patients with recurrent MDD who also had no known family history of bipolar disorder. Results: 9.6% of this large sample had a life‐time history of sub‐threshold manic symptoms. These patients were significantly more likely to have a history of poor response to antidepressants (OR 2.84; 95% CI 1.23–6.56; P < 0.02) and more likely to have experienced psychosis (OR 2.07; 95% CI 1.05–4.09; P < 0.04). They had also experienced more depressive episodes on average ( P = 0.006) and were more likely to have been admitted to hospital ( P < 0.03). Conclusion: Sub‐threshold manic symptoms in patients with recurrent MDD may be a useful clinical marker for poor response to antidepressants and a more morbid long‐term clinical course.