Contribution of depressive symptom load on prediction of transition to bipolar disorders: Results from the...

Depressive episodes are associated with a higher risk for the onset of bipolar disorder (BD). This study investigates the contribution of specific depressive symptoms using a multi-method approach in persons at-risk for bipolar disorders.

In the Early-BipoLife study, N = 1083 participants at risk for BD were examined over two years (baseline, 6, 12, 18, and 24 months). Out of 1083 participants, N = 57 (5.3%) transitioned to BD and/or were prescribed with a mood stabilizing medication (lithium, lamotrigine, valproic acid, carbamazepine, quetiapine). At baseline, N = 880 participants met the diagnostic criteria for lifetime major depression (lifetime MD) (SCID). Depressive symptoms were recorded using diagnostic interviews (EPIbipolar, SCID), a clinician rating (ICD-C) and a self-rating (QIDS-SR16). Binary logistic regressions were calculated to assess the prospective association between depressive symptoms and transition/prescription of a mood stabilizing medication.

Compared to 'no lifetime MD', 'lifetime MD' were at higher risk for transition and/or prescription of a mood stabilizing medication (OR = 2.87, 95%CI: 1.03-8.04). A higher QIDS-SR16 symptom load was associated with transition and/or prescription of a mood stabilizing medication (OR = 1.07, 95%CI: 1.01-1.13). Consistently and across methods, it was shown that suicidality at baseline predicted transition to BD and/or prescription of a mood stabilizing medication. Further baseline symptoms assessed by the clinicians (IDS-C), such as decreased or increased appetite and quality of mood were also predictive for this outcome.

Depressive symptom load and suicidality were robust predictors for BD. Clinician judgment can provide important information for early detection of BD.