Hypomanic Symptoms in Major Depression Linked With Treatment Resistance
Common in patients with unipolar depression, hypomanic symptoms are associated with both treatment-resistant depression and reduced remission of suicidal thoughts, according to a study in the Journal of Affective Disorders.
“[T]heir assessment is essential to identify challenging-to-treat cases and select the best pharmacological options,” wrote corresponding author Alessandro Serretti, MD, PhD, of the Kore University of Enna, Enna, Italy, and study coauthors.
The study included 1243 adults with major depressive disorder. Structured interviews and clinical rating scales, including the Young Mania Rating Scale and Montgomery-Asberg Depression Rating Scale, provided retrospective data for analysis.
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Among patients, 651, or 45%, experienced hypomanic symptoms during a major depressive episode, according to the study. Just 307 patients, or 25%, responded to treatment. Patients who achieved treatment response and patients who achieved remission from suicidal ideation tended to have lower scores on the Young Mania Rating Scale.
Hypomanic symptoms were negatively associated with treatment response in multivariate analysis (researchers reported a 0.71–0.87 odds ratio). Meanwhile, bipolar spectrum markers, including age at onset (1.00–1.03 odds ratio) and MDD recurrence (0.47–0.89 odds ratio), predicted remission from suicidal ideation.
“Medications commonly used to treat bipolar disorder showed some benefits, with dopamine/serotonin antagonists improving suicide ideation (P < 0.0001) and mood stabilizers being associated with reduced hypomanic symptoms (P = 0.0003),” researchers reported.
Nevertheless, concomitant use of mood stabilizers in patients with depression with hypomanic features was only marginally helpful, the study advised.
Limitations of the study included a lack of prospective clinical assessment as well as a lack of treatment randomization, the authors noted.
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