Comprehensive Psychiatry
Volume 44, Issue 2 , Pages 102-109 , March 2003

Is there a link between atypical and early-onset “unipolar” depression and bipolar II disorder?

References 

  1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. Ed. 4, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000;
  2. Marneros A, Angst J. Bipolar disorders: roots and evolution. In:  Marneros A,  Angst J editor. Bipolar Disorders: 100 Years After Manic-Depressive Insanity. Dordrecht: the Netherlands: Kluwer Academic; 2000;p. 1–36
  3. Pages KP, Dunner DL. Focus on dysthymic disorder and chronic depressions. In:  Dunner DL,  Rosenbaum JF editor. The Psychiatric Clinics of North America Annual of Drug Therapy 1997. Philadelphia, PA: Saunders; 1997;p. 91–109
  4. Goodwin FK, Jamison KR. Manic-Depressive Illness. New York, NY: Oxford University Press; 1990;
  5. Kupfer DJ, Pickar D, Himmelhoch JM, Detre TP. Are there two types of unipolar depression?. Arch Gen Psychiatry. 1975;32:866–871
  6. Winokur G. Unipolar depression: is it divisible into autonomous subtypes?. Arch Gen Psychiatry. 1979;36:47–52
  7. Winokur G. Is there a common genetic factor in bipolar and unipolar affective disorder?. Compr Psychiatry. 1980;21:460–468
  8. Winokur G, Clayton P. Family history studies: I. Two types of affective disorders separated according to genetic and clinical factors. In:  Wortis J editors. Recent Advances in Biological Psychiatry. Vol. 10:New York, NY: Plenum; 1967;p. 35–50
  9. Mendels J. Lithium in the treatment of depression. Am J Psychiatry. 1976;133:373–378
  10. Dunner DL, Dwyer T, Fieve RR. Depressive symptoms in patients with unipolar and bipolar affective disorder. Compr Psychiatry. 1976;17:447–451
  11. Dunner DL. Unipolar and bipolar depression: recent findings from clinical and biological studies. In: The Psychobiology of Affective Disorders. Pfizer Sympomsium. Depression. Basel: Switzerland: Karger; 1980;p. 11–24
  12. Endicott J, Nee J, Andreasen N, Clayton P, Keller M, Coryell W. Bipolar II. Combine or keep separate?. J Affect Disord. 1985;8:17–28
  13. Akiskal HS. The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J Clin Psychopharmacol. 1996;16(Suppl 1):4S–14S
  14. Akiskal HS. Mood disorders: Clinical features. In:  Sadock BJ,  Sadock VA editor. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Ed. 7 on CD-ROM. Philadelphia, PA: Lippincott Williams & Wilkins; 2000;p. 28294–29391
  15. Baldessarini RJ. A plea for integrity of the bipolar disorder concept. Bipolar Disord. 2000;2:3–7
  16. McMahon FJ, Stine OC, Chase GA, Meyers DA, Simpson SG, DePaulo JR. Influence of clinical subtype, sex, and lineality on age at onset of major affective disorder in a family sample. Am J Psychiatry. 1994;151:210–215
  17. O'Mahony E, Corvin A, O'Connell R, Comerford C, Larsen B, Jones IR, et al.  Sibling pairs with affective disorders: resemblance of demographic and clinical features. Psychol Med. 2002;32:55–61
  18. Akiskal HS, Pinto O. The evolving bipolar spectrum: prototypes I, II, III, and IV. Psychiatr Clin North Am. 1999;22:517–534
  19. Akiskal HS, Pinto O. The soft bipolar spectrum: footnotes to Kraepelin on the interface of hypomania, temperament and depression. In:  Marneros A,  Angst J editor. Bipolar Disorders: 100 Years After Manic-Depressive Insanity. Dordrecht: the Netherlands: Kluwer Academic; 2000;p. 37–62
  20. Benazzi F. Depressive mixed states: unipolar and bipolar II. Eur Arch Psychiatry Clin Neurosci. 2000;250:249–253
  21. Benazzi F. Major depressive episodes with hypomanic symptoms are common among depressed outpatients. Compr Psychiatry. 2001;42:139–143
  22. Benazzi F. Sensitivity and specificity of clinical markers for the diagnosis of bipolar II disorder. Compr Psychiatry. 2001;42:461–465
  23. Benazzi F, Akiskal HS. Delineating bipolar II mixed states in the Ravenna-San Diego collaborative study: the relative prevalence and diagnostic significance of hypomanic features during major depressive episodes. J Affect Disord. 2001;67:115–122
  24. Akiskal HS, Bourgeois ML, Angst J, Post R, Moller H-J, Hirschfeld R. Re-evaluating the prevalence and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord. 2000;59(Suppl 1):S5–S30
  25. Benazzi F. Prevalence of bipolar II disorder in outpatient depression: a 203-case study in private practice. J Affect Disord. 1997;43:163–166
  26. Benazzi F. Bipolar II depression in late life: prevalence and clinical features in 525 depressed outpatients. J Affect Disord. 2001;66:13–18
  27. Benazzi F, Akiskal HS. Refining the evaluation of bipolar II: beyond the strict SCID-CV guidelines for hypomania. J Affect Disord. 2003;73:33–38
  28. Hantouche EG, Akiskal HS, Lencrenon S, Allilaire J-F, Sechter D, Azorin J-M, et al.  Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a french national multi-site study (EPIDEP). J Affect Disord. 1998;50:163–173
  29. Cassano GB, Akiskal HS, Savino M, Musetti L, Perugi G, Soriani A. Proposed subtypes of bipolar II and related disorders: with hypomanic episodes (or cyclothymia) and with hyperthymic temperament. J Affect Disord. 1992;26:127–140
  30. Perugi G, Akiskal HS, Lattanzi L, Cecconi D, Mastrocinque C, Patronelli A, et al.  The high prevalence of “soft” bipolar (II) features in atypical depression. Compr Psychiatry. 1998;39:63–71
  31. Angst J. Comorbidity of mood disorders: a longitudinal prospective study. Br J Psychiatry. 1996;168(Suppl 30):31–37
  32. Benazzi F. Antidepressant-associated hypomania in outpatient depression: a 203-case study in private practice. J Affect Disord. 1997;46:73–76
  33. Altshuler LL, Post RM, Leverich GS, Mikalauskas K, Rosoff A, Ackerman L. Antidepressant-induced mania and cycle acceleration: a controversy revisited. Am J Psychiatry. 1995;152:1130–1138
  34. Koukopoulos A, Koukopoulos A. Agitated depression as a mixed state and the problem of melancholia. Psychiatr Clin North Am. 1999;22:547–564
  35. Kilzieh N, Akiskal HS. Rapid-cycling bipolar disorder. Psychiatr Clin North Am. 1999;22:585–607
  36. Ghaemi SN, Boiman EE, Goodwin FK. Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. J Clin Psychiatry. 2000;61:804–808
  37. Rihmer Z, Pestality P. Bipolar II disorder and suicidal behavior. Psychiatr Clin North Am. 1999;22:667–673
  38. Perugi G, Toni C, Akiskal HS. Anxious-bipolar comorbidity. Psychiatr Clin North Am. 1999;22:565–583
  39. Sonne SC, Brady KT. Substance abuse and bipolar comorbidity. Psychiatr Clin North Am. 1999;22:609–627
  40. Benazzi F. Prevalence and clinical correlates of residual depressive symptoms in bipolar II disorder. Psychother Psychosom. 2001;70:232–238
  41. Coryell W, Endicott J, Maser JD, Keller MB, Leon AC, Akiskal HS. Long-term stability of polarity distinctions in the affective disorders. Am J Psychiatry. 1995;152:385–390
  42. Coryell W. Bipolar II disorder: the importance of hypomania. In:  Goldberg JF,  Harrow M editor. Bipolar Disorders. Clinical Course and Outcome. Washington, DC: American Psychiatric Press; 1999;p. 219–236
  43. Kelsoe JR. Mood disorders: Genetics. In:  Sadock BJ,  Sadock VA editor. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Ed. 7 on CD-ROM. Philadelphia, PA: Lippincott Williams & Wilkins; 2000;p. 27813–27989
  44. McMahon FJ, Simpson SG, McInnis MG, Badner JA, MacKinnon DF, DePaulo JR. Linkage of bipolar disorder to chromosome 18q and the validity of bipolar II disorder. Arch Gen Psychiatry. 2001;58:1025–1031
  45. Ghaemi SN. Dr. Ghaemi replies. High prevalence of bipolar spectrum disorders, by Benazzi F. [letter] J Clin Psychiatry. 2001;62:735–736
  46. Goldberg JF, Kocsis JH. Depression in the course of bipolar disorder. In:  Goldberg JF,  Harrow M editor. Bipolar Disorders. Clinical Course and Outcome. Washington, DC: American Psychiatric Press; 1999;p. 129–147
  47. Post RM, Nolen WA, Kupka RW, Denicoff KD, Leverich GS, Keck PE, et al.  The Stanley Foundation Bipolar Network. 1. Rationale and methods. Br J Psychiatry. 2001;178(Suppl):s169–s176
  48. Angst J, Sellaro R, Merikangas KR. Depressive spectrum diagnoses. Compr Psychiatry. 2000;41(Suppl 2):39–47
  49. Judd LL, Akiskal HS. Delineating the longitudinal structure of depressive illness: beyond clinical subtypes and duration thresholds. Pharmacopsychiatry. 2000;33:3–7
  50. Benazzi F. Borderline personality disorder and bipolar II disorder in private practice depressed outpatients. Compr Psychiatry. 2000;41:106–110
  51. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV). Washington, DC: American Psychiatric Press; 1997;
  52. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. Ed 4. Washington, DC: American Psychiatric Association; 1994;
  53. Dunner DL, Tay KL. Diagnostic reliability of the history of hypomania in bipolar II patients and patients with major depression. Compr Psychiatry. 1993;34:303–307
  54. Dunner DL. Diagnostic revisions for DSM-IV. In:  Goodnick PL editors. Mania. Clinical and Research Perspectives. Washington, DC: American Psychiatric Press; 1998;p. 3–10
  55. Benazzi F. Is 4 days the minimum duration of hypomania in bipolar II disorder?. Eur Arch Psychiatry Clin Neurosci. 2001;251:32–34
  56. Angst J. The emerging epidemiology of hypomania and bipolar II disorder. J Affect Disord. 1998;50:143–151
  57. Akiskal HS, Djenderedjian AH, Rosenthal RH, Khani MK. Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. Am J Psychiatry. 1977;134:1227–1233
  58. Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Keller M, et al.  Switching from “unipolar” to bipolar II. An 11-year prospective study of clinical and temperamental predictors in 559 patients. Arch Gen Psychiatry. 1995;52:114–123
  59. Weissman MM, Wickramaratne P, Adams P, Wolk S, Verdeli H, Olfson M. Brief screening for family psychiatric history. The Family History Screen. Arch Gen Psychiatry. 2000;57:675–682
  60. Young RC, Klerman GL. Mania in late life: focus on age at onset. Am J Psychiatry. 1992;149:867–876
  61. Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970;126:983–987
  62. Kendler KS, Thornton LM, Gardner CO. Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression. Am J Psychiatry. 2001;158:582–586
  63. Kessing LV, Andersen PK, Mortensen PB, Bolwig TG. Recurrence in affective disorder. I. Case register study. Br J Psychiatry. 1998;172:23–28
  64. Akiskal HS, Hantouche EG, Bourgeois ML, Azorin JM, Sechter D, Allilaire JF, et al.  Gender, temperament, and the clinical picture in dysphoric mixed mania: findings from a French national study (EPIMAN). J Affect Disord. 1998;50:175–186
  65. Freeman MP, McElroy SL. Clinical picture and etiologic models of mixed states. Psychiatr Clin North Am. 1999;22:535–546
  66. Dayer A, Aubry J-M, Roth L, Ducrey S, Bertschy G. A theoretical reappraisal of mixed states: dysphoria as a third dimention. Bipolar Disord. 2000;2:316–324
  67. Armitage P, Berry G. Statistical Methods in Medical Research. Oxford, UK: Blackwell Scientific Publications. 1987;
  68. Sullivan PF, Kessler RC, Kendler KS. Latent class analysis of lifetime depressive symptoms in the national comorbidity survey. Am J Psychiatry. 1998;155:1398–1406
  69. Rothman KJ, Greenland S. Modern Epidemiology. Ed 2. Philadelphia, PA: Lippincott Williams & Wilkins; 1998;
  70. Benazzi F. High prevalence of bipolar spectrum disorders. J Clin Psychiatry. 2001;62:735–736
  71. Brugha TS, Jenkins R, Taub N, Meltzer H, Bebbington PE. A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Psychol Med. 2001;31:1001–1013
  72. Benazzi F. Highly recurrent unipolar may be related to bipolar II. Compr Psychiatry. 2002;43:263–268

 Address reprint requests to Franco Benazzi, M.D., Via Pozzetto 17, 48015 Castiglione di Cervia RA, Italy.

☆☆ 0010-440X/03/4402-0001$30.00/0

PII: S0010-440X(03)00035-X

doi: 10.1053/comp.2003.50015

Comprehensive Psychiatry
Volume 44, Issue 2 , Pages 102-109 , March 2003