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Depressive mixed state frequency: age/gender effects
1The Outpatient Psychiatry Private Center, A University of California in San Diego Collaborating Center, Ravenna and Forlì, Italy. f.benazzi@fo.nettuno.it
Abstract:
Depressive mixed state (DMX), a major depressive episode (MDE) combined with few manic/hypomanic symptoms, is understudied. Age and gender are important variables in mood disorders. The aim of the present study was to determine whether age and gender had any effect on the frequency of DMX. Consecutive unipolar (n = 144) and bipolar II (n = 218) drug-free MDE out-patients were interviewed with the Structured Clinical Interview for DSM-IV when presenting for MDE treatment. The presence of hypomanic symptoms during the index MDE was assessed systematically. Depressive mixed state was defined as a MDE with three or more concurrent hypomanic symptoms (DMX3), following previous reports. Associations were tested by logistic regression. The results showed that the DMX3 frequency was 43.9% and that it affected more females than males. Frequency decreased with age. The lower frequency with age was related to the lower frequency of bipolar II disorder with age. Bipolar disorder family history of DMX3 patients did not change with age. In conclusion, the frequency of DMX3 was high and related to age. The high frequency of DMX3 supports the clinical usefulness of the definition, as well as observations that antidepressants may worsen its hypomanic symptoms, whereas antipsychotics and mood stabilisers may treat them. A bipolar vulnerability seems to be required for the appearance of DMX3 also in later life.
Insights
Depressive mixed state (DMX) affects nearly half of patients, being more common in females and decreasing with age. This finding highlights the clinical relevance of DMX in mood disorder research.
Area of Science:
- Psychiatry
- Mood Disorders
- Clinical Psychology
Background:
- Depressive mixed state (DMX), characterized by a major depressive episode (MDE) with concurrent hypomanic symptoms, is understudied.
- Age and gender are known influencing factors in mood disorders, necessitating investigation into their role in DMX.
- Understanding DMX prevalence is crucial for effective diagnosis and treatment strategies.
Purpose of the Study:
- To investigate the impact of age and gender on the frequency of depressive mixed state (DMX) in patients with major depressive episodes (MDE).
- To assess the prevalence of DMX, specifically defined as MDE with three or more hypomanic symptoms (DMX3), in unipolar and bipolar II outpatients.
- To explore the relationship between age, gender, and DMX3 frequency in a clinical sample.
Main Methods:
- Systematic assessment of hypomanic symptoms during MDE using the Structured Clinical Interview for DSM-IV in 144 unipolar and 218 bipolar II drug-free outpatients.
- Definition of DMX3 as a MDE with three or more concurrent hypomanic symptoms.
- Logistic regression analysis to test associations between DMX3 frequency, age, and gender.
Main Results:
- The overall frequency of DMX3 was found to be 43.9%.
- DMX3 was significantly more prevalent in females compared to males.
- The frequency of DMX3 demonstrated a decrease with increasing age, linked to a lower prevalence of bipolar II disorder in older patients.
Conclusions:
- The high frequency of DMX3 supports its clinical significance and the utility of the established definition.
- Findings suggest a potential need for bipolar vulnerability for DMX3 development, even in later life.
- The study underscores the importance of considering age and gender in the diagnosis and management of depressive mixed states.