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5 - Recurrent brief depression as an indicator of severe mood disorders

Published online by Cambridge University Press:  10 August 2009

By
Jules Angst ,
Alex Gamma ,
Valadeta Ajdacic ,
Dominique Eich ,
Lukas Pezawas  and
Wulf Rössler
Edited by
Andreas Marneros  and
Frederick Goodwin
Jules Angst
Affiliation:
Zurich University Psychiatric Hospital Zurich Switzerland
Alex Gamma
Affiliation:
Zurich University Psychiatric Hospital Zurich Switzerland
Valadeta Ajdacic
Affiliation:
Zurich University Psychiatric Hospital Zurich Switzerland
Dominique Eich
Affiliation:
Zurich University Psychiatric Hospital Zurich Switzerland
Lukas Pezawas
Affiliation:
Zurich University Psychiatric Hospital Zurich Switzerland
Wulf Rössler
Affiliation:
Zurich University Psychiatric Hospital Zurich Switzerland
Andreas Marneros
Affiliation:
Martin Luther-Universität Halle-Wittenburg, Germany
Frederick Goodwin
Affiliation:
George Washington University, Washington DC
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Summary

Introduction

Bipolar spectrum

The bipolar spectrum is currently the focus of very intensive research, which is hampered by two interrelated biases, one methodological and one commercial. Epidemiological and clinical research in the field of bipolar disorders deals with disorders/syndromes defined according to the diagnostic manuals and uses methods tailored to them, which are not suitable for assessing subthreshold morbidity (minor and recurrent brief depression, recurrent and brief hypomania). This has significant implications for the differentiation between depression and bipolar disorder. As a consequence, major depressive disorders (MDD) are overdiagnosed and heterogeneous; they include many bipolar II (BP-II) cases, of which the hypomanic component does not reach the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV: American Psychiatric Association, 1994) or ICD-10 Classification of Mental and Behavioural Disorders (World Health Organization, 1992) diagnostic threshold for hypomania. This means that drug trials selecting patients on the basis of an MDD diagnosis are also dealing with heterogeneous groups, which include hidden BP-II subjects prone to switch into hypomania.

Moreover, current bipolar research is biased towards mania and neglects bipolar depression. The large majority of modern treatment studies on mood stabilizers select patients with mania and exclude those with BP-II disorders, although the latter are much more prevalent than the former both in clinical practice and among relatives of bipolar patients. In addition, BP-II patients have traditionally been excluded from drug trials using modern antidepressants.

Keywords

bipolar IIcombined depressioncomorbiditymood disordersrecurrent brief depressionrecurrent brief hypomaniapsychiatric syndromesrecurrent brief anxietyultrarapid cycling pattern
Type
Chapter
Information
Bipolar Disorders
Mixed States, Rapid Cycling and Atypical Forms
 , pp. 109 - 130
Publisher: Cambridge University Press
Print publication year: 2005

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