PITTSBURGH — About a third of patients with unipolar depression actually have “lifetime spectrum mania,” which means they also have symptoms of mania and anxiety disorders, based on results from a study with 148 patients.
Lifetime spectra mania “bridges the gap between bipolar and unipolar depression,” Giovanni B, Cassano, M.D., said at the Sixth International Conference on Bipolar Disorder.
These patients meet rigorous criteria for unipolar depression, but their symptoms of mania and hypomania don't meet DSM-IV criteria for bipolar disease, said Ellen Frank, Ph.D., a professor of psychiatry and psychology at the University of Pittsburgh and coinvestigator on the study.
Because this is a recent finding, it's “too soon to say” exactly what it means for patient management, but Dr. Frank offered some possible implications at the conference, sponsored by the university:
▸ These patients are much more scared of psychoactive drugs and more sensitive to the drugs' adverse effects, which means that they need to be started on a lower dose and the dose increased slowly, Dr. Frank told this newspaper. Physicians also need to provide a lot more reassurance to these patients about the adverse effects that appear.
▸ These patients have difficulty identifying their feelings. They may not distinguish irritation, anger, fear, and anxiety, so psychotherapy needs to help patients recognize what they feel and how to communicate it to others.
▸ These patients also tend to be avoiders and procrastinators who need help in engaging with others.
The message for physicians is that when a patient has unipolar depression he or she should determine whether the patient has coexisting mania and anxiety disorder. It's important to make this diagnosis because patients with all of these symptoms tend to be harder to treat, and to require more wide-ranging therapy that's applied for a longer period of time, said Dr. Frank, who is also director of the depression and manic depression prevention program at the Western Psychiatric Institute and Clinic in Pittsburgh.
The study assessed 148 patients with unipolar depression for other psychiatric symptoms. High scores for symptoms of mania, panic, obsessive-compulsive disorder, and social anxiety were seen in 34% of the patients. The remaining 66% had low scores for all of these associated symptoms; their only clear symptom was depression, reported Dr. Cassano, professor and chairman of the department of psychiatry, neurobiology, pharmacology, and biotechnology at the University of Pisa (Italy).
The study was a collaboration between the University of Pisa and the University of Pittsburgh.