Survey Reveals Hidden Bipolarity In Many Depressed Respondents

Interviews with members of more than 5,000 representative U.S.
households as part of the National Comorbidity Survey Replication found that nearly 40 percent of those with
major depressive disorder may actually have subthreshold hypomania, defined as a discrete period of increased
energy, activity, and euphoria or irritability that is not related to impairment in daily activities.


Hypomania is a less disruptive form of mania that lacks psychotic symptoms. The majority of patients with
bipolar disorder experience hypomania, rather than mania. Recognition of subthreshold hypomania, or hypomanic
symptoms below the threshold for bipolar disorder, would have implications for the diagnosis and treatment of
major depression.


Among those with subthreshold hypomania, family history of mania was just as common as it was among people
with threshold mania. In addition, compared to those with depression alone, those who had depression with
subthreshold hypomania tended to have an earlier onset of mood disorder, higher rates of anxiety and substance
abuse, and more depressive episodes. Other research has shown that young people with subthreshold hypomania
are more likely to develop bipolar disorder over time.


The findings provide key information for evaluating diagnostic criteria for mood disorders and have important
implications for promoting appropriate treatment for individuals with bipolar spectrum disorders. Author
Kathleen Merikangas, Ph.D., states, "Recognition of hypomania among people with major depression is important
in determining the future risk for the development of bipolar disorder, and should be considered in treatment
decisions among people with major depression. The increased rate of suicide attempts is of particular concern."


The study will appear on August 16 at AJP in Advance, the online advance edition of The American Journal of
Psychiatry (AJP), the official journal of the American Psychiatric Association. The National Comorbidity Survey
Replication was supported by the National Institute of Mental Health (NIMH), National Institute of Drug Abuse,
Substance Abuse and Mental Health Services Administration, Robert Wood Johnson Foundation, and John W.
Alden Trust. Manuscript preparation was supported by NIMH and the French National Center for Scientific
Research. Other funding received by individual authors is disclosed in the article.
The American Journal of Psychiatry is the oldest continuously published medical specialty journal in the United
States and was recently named one of the "Most Influential Journals in Biology & Medicine of the Last 100
Years."


Source:

American Psychiatric Association