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#Post#: 26--------------------------------------------------
Symptoms of BP Disorder May Go Undiagnosed in Some Adults w/
Major Depression
DIR By: Bipolar Girl
Date: August 31, 2010, 8:33 pm
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Symptoms of Bipolar Disorder May Go Undiagnosed in Some Adults
with Major Depression
Nearly 40 percent of people with major depression may also have
subthreshold hypomania, a form of mania that does not fully meet
current diagnostic criteria for bipolar disorder, according to a
new NIMH-funded study. The study was published online ahead of
print August 15, 2010, in the American Journal of Psychiatry.
Background
Mania is a symptom of bipolar disorder. According to the
Diagnostic and Statistical Manual for Mental Disorders (DSM-IV),
it is generally defined as a discrete period of increased
energy, activity, euphoria or irritability that leads to marked
impairment in one’s daily life. The DSM-IV states that a manic
episode lasts for one week or more, and may sometimes require
hospitalization. Hypomania is defined as a milder form of mania
that lasts for four days at a time, but does not interfere with
one’s daily activities. The majority of people diagnosed with
bipolar disorder experience repeated episodes of hypomania
rather than mania.
For this new study, Kathleen Merikangas, PhD., of NIMH, and
colleagues aimed to characterize the full spectrum of mania by
identifying hypomanic episodes that last less than four days
among those diagnosed with major depression. They described this
type of hypomania as subthreshold hypomania. Merikangas and
colleagues used data from 5,692 respondents of the National
Comorbidity Survey Replication (NCS-R), a nationally
representative survey of American adults ages 18 and older.
Results of the Study
The researchers found that nearly 40 percent of those identified
as having major depression also had symptoms of subthreshold
hypomania. Compared to those with major depression alone, those
with depression plus subthreshold hypomania tended to be younger
at age of onset and to have had more coexisting health problems,
more episodes of depression and more suicide attempts. They
also found that among those with subthreshold hypomania, a
family history of mania was just as common as it was among
people with bipolar disorder.
Significance
According to the researchers, the findings indicate that many
adults with major depression may in fact have mild but
clinically significant symptoms of bipolar disorder. In
addition, because many with subthreshold hypomania had a family
history of mania, the researchers suggest that subthreshold
hypomania may be predictive of future hypomania or mania.
Previous research has indicated that young people with
subthreshold hypomania symptoms are more likely to develop
bipolar disorder over time, compared to those without
subthreshold hypomania, said the authors.
What’s Next
The researchers suggest that depression and mania may be defined
as dimensions, rather than as discrete diagnostic categories.
Clinicians should be aware that patients who report repeated
episodes of subthreshold hypomania may have a risk of developing
mania, the researcher concluded.
Reference
Angst J, Cui L, Swendsen J, Rothen S, Cravchik A, Kessler R,
Merikangas K. Major depressive disorder with sub-threshold
bipolarity in the National Comorbidity Survey Replication.
American Journal of Psychiatry. Online ahead of print August 15,
2010.
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