Skip to main content

Advertisement

SpringerLink
Log in

Bipolar spectrum in major depressive disorders

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Growing evidence for the spectrum concept of most mental disorders, particularly mood disorders, has challenged the arbitrary distinctions inherent in the contemporary categorical diagnostic classification system. Detection of manic symptoms in the context of episodes of depression is particularly important because of the implications for differential treatment of bipolar vs unipolar depression. The purpose of this study is to characterize the magnitude and clinical correlates of subthreshold manic syndromes or symptoms among people with major depressive disorder (MDD) compared to those without a history of manic symptoms. We defined two subthreshold manifestations—manic syndrome or symptoms—that did not include a criterion for duration. In the context of MDD, we found that the clinical correlates of those with the subthreshold manic syndrome were more similar to those with bipolar-II disorder than to MDD alone, whereas those with manic symptoms only were intermediate between those with subthreshold manic syndrome and MDD alone. These results confirm the spectrum concept of mania and suggest that a manic syndrome should be considered when evaluating people with MDD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Akiskal HS (2002) The bipolar spectrum—the shaping of a new paradigm in psychiatry. Curr Psychiatry Rep 4:1–3

    Article  Google Scholar 

  2. Angst J (2007) The bipolar spectrum. Br J Psychiatry 190:189–191. https://doi.org/10.1192/bjp.bp.106.030957

    Article  PubMed  Google Scholar 

  3. Judd LL, Akiskal HS (2003) The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 73:123–131

    Article  Google Scholar 

  4. Regeer EJ, ten Have M, Rosso ML, Hakkaart-van Roijen L, Vollebergh W, Nolen WA (2004) Prevalence of bipolar disorder in the general population: a Reappraisal Study of the Netherlands Mental Health Survey and Incidence Study. Acta Psychiatr Scand 110:374–382. https://doi.org/10.1111/j.1600-0447.2004.00363.x

    Article  CAS  PubMed  Google Scholar 

  5. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RMA, Petukhova M, Kessler RC (2007) Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry 64:543–552. https://doi.org/10.1001/archpsyc.64.5.543

    Article  PubMed  PubMed Central  Google Scholar 

  6. Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, Viana MC, Andrade LH, Hu C, Karam EG, Ladea M, Medina-Mora ME, Ono Y, Posada-Villa J, Sagar R, Wells JE, Zarkov Z (2011) Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 68:241–251. https://doi.org/10.1001/archgenpsychiatry.2011.12

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hoertel N, Le Strat Y, Angst J, Dubertret C (2013) Subthreshold bipolar disorder in a U.S. national representative sample: prevalence, correlates and perspectives for psychiatric nosography. J Affect Disord 146:338–347. https://doi.org/10.1016/j.jad.2012.09.016

    Article  PubMed  Google Scholar 

  8. Lewinsohn PM, Klein DN, Seeley JR (1995) Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Am Acad Child Adolesc Psychiatry 34:454–463

    Article  CAS  Google Scholar 

  9. Birmaher B, Axelson D, Strober M, Gill MK, Yang M, Ryan N, Goldstein B, Hunt J, Esposito-Smythers C, Iyengar S, Goldstein T, Chiapetta L, Keller M, Leonard H (2009) Comparison of manic and depressive symptoms between children and adolescents with bipolar spectrum disorders. Bipolar Disord 11:52–62. https://doi.org/10.1111/j.1399-5618.2008.00659.x

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zimmermann P, Brueckl T, Nocon A, Pfister H, Lieb R, Wittchen H-U, Holsboer F, Angst J (2010) Heterogeneity of DSM-IV major depressive disorder as a consequence of subthreshold bipolarity (poster P01-82). In: 18th European congress of psychiatry, 27 February–2 March 2010. European Psychiatry, Munich

  11. Merikangas KR, Cui L, Kattan G, Carlson G, Youngstrom EA, Angst J (2012) Mania with and without depression in a community sample of U.S. adolescents. Arch Gen Psychiatry 69:943–951. https://doi.org/10.1001/archgenpsychiatry.2012.38

    Article  PubMed  Google Scholar 

  12. Merikangas K, Herrell R, Swendsen J, Rössler W, Ajdacic-Gross V, Angst J (2008) Specificity of bipolar spectrum conditions in the comorbidity of mood and substance use disorders: results from the Zurich cohort study. Arch Gen Psychiatry 65:47–52. https://doi.org/10.1001/archgenpsychiatry.2007.18

    Article  PubMed  Google Scholar 

  13. Kenneson A, Funderburk JS, Maisto SA (2013) Risk factors for secondary substance use disorders in people with childhood and adolescent-onset bipolar disorder: opportunities for prevention. Compr Psychiatry 54:439–446. https://doi.org/10.1016/j.comppsych.2012.12.008

    Article  PubMed  Google Scholar 

  14. Angst J, Cui L, Swendsen J, Rothen S, Cravchik A, Kessler R, Merikangas K (2010) Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. Am J Psychiatry 167:1194–1201. https://doi.org/10.1176/appi.ajp.2010.09071011

    Article  PubMed  PubMed Central  Google Scholar 

  15. Khazanov GK, Cui L, Merikangas Ries K, Angst J (2015) Treatment patterns of youth with bipolar disorder: results from the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Abnormal Child Psychol 43:391–400. https://doi.org/10.1007/s10802-014-9885-6

    Article  Google Scholar 

  16. Regeer EJ, Kupka RW, ten Have M, Vollebergh W, Nolen WA (2015) Low self-recognition and awareness of past hypomanic and manic episodes in the general population. Int J Bipolar Disord. https://doi.org/10.1186/s40345-015-0039-8

    Article  PubMed  PubMed Central  Google Scholar 

  17. Stewart C, El-Mallakh RS (2007) Is bipolar disorder overdiagnosed among patients with substance abuse? Bipolar Disord 9:646–648. https://doi.org/10.1111/j.1399-5618.2007.00465.x

    Article  PubMed  Google Scholar 

  18. Goldberg JF, Garno JL, Callahan AM, Kearns DL, Kerner B, Ackerman SH (2008) Overdiagnosis of bipolar disorder among substance use disorder inpatients with mood instability. J Clin Psychiatry 69:1751–1757

    Article  Google Scholar 

  19. Merikangas KR, Cui L, Heaton L, Nakamura E, Roca C, Ding J, Qin H, Guo W, Yao-Shugart Y, Zarate C, Angst J (2014) Independence of familial transmission of mania and depression: results of the NIMH family study of affective spectrum disorders. Mol Psychiatry 19:214–219. https://doi.org/10.1038/mp.2013.116

    Article  CAS  PubMed  Google Scholar 

  20. Angst J, Paksarian D, Cui L, Merikangas KR, Hengartner MP, Ajdacic-Gross V, Rössler W (2016) The epidemiology of common mental disorders from age 20 to 50: results from the prospective Zurich Cohort Study. Epidemiol Psychiatr Sci 25:24–32. https://doi.org/10.1017/S204579601500027X

    Article  CAS  PubMed  Google Scholar 

  21. Derogatis LR (1977) SCL-90. Administration, scoring and procedures manual-I for the R (revised) version and other instruments of the Psychopathology Rating Scale Series. Johns Hopkins University School of Medicine, Baltimore

    Google Scholar 

  22. Dunn G, Pickles A, Tansella M, Vazquez-Barquero J-L (1999) Two-phase epidemiological surveys in psychiatry. Br J Psychiatry 174:95–100

    Article  CAS  Google Scholar 

  23. Perugi G, Angst J, Azorin J, Bowden CL, Mosolov S, Reis J, Vieta E, Young AH (2015) Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study. J Clin Psychiatry 76:e351–e358. https://doi.org/10.4088/JCP.14m09092

    Article  PubMed  Google Scholar 

  24. Angst J, Dobler-Mikola A, Binder J (1984) The Zurich Study—a prospective epidemiological study of depressive, neurotic and psychosomatic syndromes. I. Problem, methodology. Eur Arch Psychiatry Neurol Sci 234:13–20

    Article  CAS  Google Scholar 

  25. Angst J, Gamma A, Neuenschwander M, Ajdacic-Gross V, Eich D, Rössler W, Merikangas KR (2005) Prevalence of mental disorders in the Zurich cohort study: a twenty year prospective study. Epidemiol Psychiatr Soc 14:68–76

    Article  Google Scholar 

  26. Depue RA (1987) General behavior inventory (Manual). Assessment manual. University of Minnesota, Minneapolis

    Google Scholar 

  27. Angst J (2013) Bipolar disorders in DSM-5: strengths, problems and perspectives. Int J Bipolar Disord. https://doi.org/10.1186/2194-7511-1-12

    Article  PubMed  PubMed Central  Google Scholar 

  28. Angst J, Gamma A, Bowden CL, Azorin JM, Perugi G, Vieta E, Young AH (2012) Diagnostic criteria for bipolarity based on an international sample of 5,635 patients with DSM-IV major depressive episodes. Eur Arch Psychiatry Clin Neurosci 262:3–11. https://doi.org/10.1007/s00406-011-0228-0

    Article  CAS  PubMed  Google Scholar 

  29. Beesdo-Baum K, Knappe S, Asselmann E, Zimmermann P, Brückl T, Höfler M, Behrendt S, Lieb R, Wittchen HU (2015) The ‘Early Developmental Stages of Psychopathology (EDSP) study’: a 20-year review of methods and findings. Soc Psychiatry Epidemiol 50:851–866. https://doi.org/10.1007/s00127-015-1062-x

    Article  Google Scholar 

  30. Spijker J, De Graaf R, Bijl RV, Beekman ATF, Ormel J, Nolen WA (2004) Determinants of persistence of major depressive episodes in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). J Affect Disord 81:231–240. https://doi.org/10.1016/j.jad.2003.08.005

    Article  PubMed  Google Scholar 

  31. Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer T, Skeppar P, Vieta E, Scott J (2005) The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 88:217–233. https://doi.org/10.1016/j.jad.2005.05.011

    Article  PubMed  Google Scholar 

  32. Feng Y, Xiang YT, Huang W, Wang G, Feng L, Tian TF, Geng Y, Ungvari GS, Chiu HF, Tse AW, Angst J (2016) The 33-item Hypomania Checklist (HCL-33): a new self-completed screening instrument for bipolar disorder. J Affect Disord 190:214–220. https://doi.org/10.1016/j.jad.2015.09.057

    Article  PubMed  Google Scholar 

  33. Lojko D, Dudek D, Angst J, Siwek M, Michalak M, Rybakowski JK (2016) The 33-item Hypomania Checklist (HCL-33)—a study of the consistency between self- and external assessments in Polish bipolar patients. Psychiatr Pol 50:1085–1092. https://doi.org/10.12740/PP/66358

    Article  PubMed  Google Scholar 

  34. Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, Sanislow C, Wang P (2010) Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry 167:748–751. https://doi.org/10.1176/appi.ajp.2010.09091379

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by Grant nos. 3200-050881.97/1 and 32-50881.97 of the Swiss National Science Foundation.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland

    J. Angst, V. Ajdacic-Gross & W. Rössler

  2. Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA

    K. R. Merikangas, L. Cui & A. Van Meter

  3. Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA

    A. Van Meter

  4. Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of São Paulo, São Paulo, Brazil

    W. Rössler

  5. Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany

    W. Rössler

Authors
  1. J. Angst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. R. Merikangas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Van Meter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. V. Ajdacic-Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W. Rössler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Angst.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The project received prior approval (1978) from the Ethical Committee of the Zurich University Psychiatric Hospital.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Angst, J., Merikangas, K.R., Cui, L. et al. Bipolar spectrum in major depressive disorders. Eur Arch Psychiatry Clin Neurosci 268, 741–748 (2018). https://doi.org/10.1007/s00406-018-0927-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-018-0927-x

Keywords

Search

Navigation