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: 3.71). 09/2008; 114(1-3):58-67. DOI: 10.1016/j.jad.2008.07.006
Source: PubMed

ABSTRACT 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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Available from: Michael H Allen, Aug 15, 2015
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    • "The primary outcome measure, of an improvement in subsyndromal mood symptoms in the Eye Movement Desensitization and Reprocessing group, was met: we found a statistically significant mood stabilizing effect for both depressive and (hypo)manic symptoms in instable bipolar patients at the end of the Eye Movement Desensitization and Reprocessing intervention. Documenting improvement in subsyndromal mood symptoms is of clinical relevance, since these are frequent in bipolar disorder and have been found to be associated with a higher risk of poor outcome on a variety of measures and are difficult to control with medication (Altshuler et al., 2006; Paykel et al., 2006; Judd et al., 2008; Marangell et al., 2009). Also, the study provides a 'proof-ofprinciple' that bipolar disorder is susceptible to treatment with a form of trauma-directed therapy. "
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    Psychiatry Research 05/2014; DOI:10.1016/j.psychres.2014.05.012i · 2.68 Impact Factor
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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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    • "Although improvement of symptomatology is related to fewer occupational and relational deficits, patients with minor or subsyndromal levels of depression have psychosocial impairments similar to those with major depression. Some degree of impairment remains present even during remission (Kennedy et al., 2007; Marangell et al., 2009). A 15-year follow-up among unipolar and bipolar patients showed moderate to severe dysfunction more than 26% of the time (Judd et al., 2008), indicating the impact of depression on daily functioning. "
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