@article{81ec95f3b65f45cca7e605d78f89c28f,
title = "Mania and bipolar depression: complementing not opposing poles—a post-hoc analysis of mixed features in manic and hypomanic episodes",
abstract = "Background: Depending on the classification system used, 5–40% of manic subjects present with concomitant depressive symptoms. This post-hoc analysis evaluates the hypothesis that (hypo)manic subjects have a higher burden of depression than non-(hypo)manic subjects. Methods: Data from 806 Bipolar I or II participants of the Stanley Foundation Bipolar Network (SFBN) were analyzed, comprising 17,937 visits. A split data approach was used to separate evaluation and verification in independent samples. For verification of our hypotheses, we compared mean IDS-C scores ratings of non-manic, hypomanic and manic patients. Data were stored on an SQL-server and extracted using standard SQL functions. Linear correlation coefficients and pivotal tables were used to characterize patient groups. Results: Mean age of participants was 40 ± 12 years (range 18–81). 460 patients (57.1%) were female and 624 were diagnosed as having bipolar I disorder (77.4%) and 182 with bipolar II (22.6%). Data of 17,937 visits were available for analyses, split into odd and even patient numbers and stratified into three groups by YMRS-scores: not manic < 12, hypomanic < 21, manic < 30. Average IDS-C sum scores in manic or hypomanic states were significantly higher (p <.001) than for non-manic states. (Hypo)manic female patients were likely to show more depressive symptoms than males (p <.001). Similar results were obtained when only the core items of the YMRS or only the number of depressive symptoms were considered. Analyzing the frequency of (hypo)manic mixed states applying a proxy of the DSM-5 mixed features specifier extracted from the IDS-C, we found that almost 50% of the (hypo)manic group visits fulfilled DSM-5 mixed features specifier criteria. Conclusion: Subjects with a higher manic symptom load are also significantly more likely to experience a higher number of depressive symptoms. Mania and depression are not opposing poles of bipolarity but complement each other.",
keywords = "Bipolar disorder, Depression, Hypomania, Mania, Mixed states",
author = "Christoph Born and Heinz Grunze and Post, {Robert M.} and Altshuler, {Lori L.} and Ralph Kupka and McElroy, {Susan L.} and Frye, {Mark A.} and Trisha Suppes and Keck, {Paul E.} and Nolen, {Willem A.} and Lars Schaerer",
note = "Funding Information: Open Access funding enabled and organized by Projekt DEAL. Part of his work was supported by the Stanley Medical Research Institute. Funding Information: Robert Post has received speaker{\textquoteright}s honoraria over the past 3 years from AstraZeneca, Validus, Sunovion, Takeda, Pamlabs. Ralph Kupka has received honoraria and royalties over the past 3 years from UpToDate and De Tijdstroom/Boom publishers. Susan McElroy is a consultant to or member of the scientific advisory boards of Bracket, F. Hoffmann-La Roche Ltd., MedAvante, Mitsubishi Tanabe Pharma America, Myriad, Novo Nordisk, Shire, and Sunovion. She is a principal or co-investigator on studies sponsored by the Allergan, Brainsway, Marriott Foundation, Myriad, National Institute of Mental Health, Novo Nordisk, Shire, and Sunovion. She is also an inventor on United States Patent No. 6,323,236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders, and along with the patent{\textquoteright}s assignee, University of Cincinnati, Cincinnati, Ohio, has received payments from Johnson & Johnson, which has exclusive rights under the patent. Mark A. Frye has received grant support from AssureRx, Mayo Foundation, Myriad, National Institute of Alcohol Abuse and Alcoholism (NIAAA), NationalInstitute of Mental Health (NIMH), Pfizer. He has served as a consultant (Mayo) to Janssen, Mitsubishi Tanabe Pharma Corporation, Myriad, Neuralstem Inc., Otsuka American Pharmaceutical, Sunovion, Teva Pharmaceuticals. His employer Mayo Clinic has a financial interest in AssureRX and the technology referenced in this publication/presentation. Heinz Grunze received grants/research support, consulting fees and honoraria within the last 3 years from Gedeon Richter, Janssen-Cilag, and Servier. Trisha Suppes, MD, PhD, in the past 36 months, has reported: Grants from Merck, National Institute on Drug Abuse, National Institute of Health, VA Cooperative Studies Program, and VA OR&D PRIME Care, Palo Alto Health Sciences, Stanley Medical Research Institute, Pathways Genomics. Consulting fees from Allergan, Inc., Intracellular Therapies, Sunovion Pharmaceuticals, Inc., and Impel NeuroPharma Inc. Honoraria from CME Institute (Physicians Postgraduate Press, Inc.) and CMEology. Royalties from American Psychiatric Association Publishing, Hogrefe Publishing, Jones and Bartlett, and Wolters Kluwer Health (UpToDate). Travel reimbursement from Sunovion Pharmaceuticals, Inc. Paul Keck Jr has been reimbursed for consulting to Otsuka and Lyndra. He is a co- inventor on United States Patent No. 6387956: Shapira NA, Goldsmith TD, Keck, PE Jr. (University of Cincinnati) Methods of treating obsessive–compulsive spectrum disorder comprises the step of administering an effective amount of tramadol to an individual. Filed March 25, 1999; approved May 14, 2002. Dr. Keck has received no financial gain from this patent. W.A. Nolen has received grants from the Netherlands Organisation for Health Research and Development, the European Union; has received honoraria/speaker{\textquoteright}s fees over the past 5 years from Lundbeck and Aristo Pharma, and has served over the past 5 years as consultant for Daleco Pharma. Publisher Copyright: {\textcopyright} 2021, The Author(s).",
year = "2021",
month = dec,
doi = "10.1186/s40345-021-00241-5",
language = "English (US)",
volume = "9",
journal = "International Journal of Bipolar Disorders",
issn = "2194-7511",
publisher = "Springer Open",
number = "1",
}