The functional impact of subsyndromal depressive symptoms in bipolar disorder: Data from STEP-BD

Mood Disorders Center, Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 09/2008; 114(1-3):58-67. DOI: 10.1016/j.jad.2008.07.006
Source: PubMed


This report describes baseline characteristics and functional outcomes of subjects who have prospectively observed subsyndromal symptoms after a major depressive episode (MDE).
All subjects were participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). We identified subjects with at least 2 years of observation whose prior or current episode was a MDE, and who were in a stable clinical state of either recovered (no more than 2 moderate symptoms for at least 8 weeks), a MDE by DSM-IV criteria, or with continued subsyndromal symptoms. The subsyndromal group was defined a priori as 3 or more moderate affective symptoms but without meeting diagnostic criteria for major depression.
The final cohort included 1094 recovered, 112 subsyndromal, and 310 individuals in a MDE. The average time spent in each clinical status ranged from 120 to 132 days. The subsyndromal group was most similar to those in a MDE, differing only on the intensity of depressive symptoms and the number of work days missed due to ongoing symptoms. Reported sadness, inability to feel and lassitude were each associated with multiple measures of impairment.
This study is limited by the cross-sectional approach to defining outcomes.
These findings are consistent with studies in unipolar major depression that indicate that functional impairment observed in the context of subsyndromal depressive symptoms is comparable to that of a full episode. This work underscores the need to include subsyndromal symptoms in study outcomes and to target full remission in clinical practice.

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    • "They had no close friends and almost no social contacts. Interpersonal difficulties in depression have been observed by some previous researchers as well [24, 25]. Thus, depressed patients have relationship problems with both close relations and nonintimates and this does not differ by polarity as our results suggest. "
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    Depression research and treatment 03/2014; 2014:302741. DOI:10.1155/2014/302741
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    • "QoL, and the boundary between euthymia and subsyndromal symptoms is not always clear (Harvey, 2006; Marangell et al., 2009). Therefore the characterization of the QoL with specific cut-off points in this specific population may provide more clinically meaningful information from the perspective of the patients and their experience of this complex condition as well as of the impact of treatment interventions. "
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