Subsyndromal Depressive Symptoms Are Associated With Functional Impairment in Patients With Bipolar Disorder

Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center, CA, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 10/2006; 67(10):1551-60. DOI: 10.4088/JCP.v67n1009
Source: PubMed


Studies of patients with unipolar depression have demonstrated a relationship between subthreshold depressive symptoms and impairment in role functioning. Research examining this relationship in persons with bipolar disorder is rare. This study sought to evaluate the association between subsyndromal depressive symptoms and role functioning in subjects with bipolar disorder.
759 adult outpatients with a DSM-IV diagnosis of bipolar disorder were entered into this study at 7 different sites in the Stanley Foundation Bipolar Network (SFBN) beginning in March 1996 and ending in November 2002 and were followed longitudinally for assessment of their course of illness. Subsyndromal depression was operationalized using cutoff scores on the Inventory for Depressive Symptomatology-Clinician Rated (IDS-C), and patients were divided into 3 groups: not depressed (IDS-C score < 13), subsyndromally depressed (IDS-C score 13 to 27), and syndromally depressed (IDS-C score >or= 28). Groups were compared using a series of chi(2) analyses on degree of role function impairment across 4 role domains (work, home duties, family life, and friendships) from the Life Functioning Questionnaire. Logistic regression was used to estimate the probability of any impairment in life functioning based on severity of depressive symptoms.
Subsyndromally depressed patients were significantly more likely than those not depressed to report impairment in their work and home functioning roles, as well as impairment in relations with family and friends (p < .001). Across all domains of role function, the proportion of patients impaired in the subsyndromally depressed group was more similar to the syndromally depressed group than to the not depressed group.
These findings clearly demonstrate the public health significance of subsyndromal depression in the bipolar population. The most appropriate interventions for subsyndromal depressive symptoms in patients with bipolar disorder remain to be determined.

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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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    ABSTRACT: Introduction. Major depressive disorder (MDD) and bipolar affective disorder (BAD) are among the leading causes of disability. These are often associated with widespread impairments in all domains of functioning including relational, occupational, and social. The main aim of the study was to examine and compare nature and extent of psychosocial impairment of patients with MDD and BAD during depressive phase. Methodology. 96 patients (48 in MDD group and 48 in BAD group) were included in the study. Patients were recruited in depressive phase (moderate to severe depression). Patients having age outside 18-45 years, psychotic symptoms, mental retardation, and current comorbid medical or axis-1 psychiatric disorder were excluded. Psychosocial functioning was assessed using Range of Impaired Functioning Tool (LIFE-RIFT). Results. Domains of work, interpersonal relationship, life satisfaction, and recreation were all affected in both groups, but the groups showed significant difference in global psychosocial functioning score only (P = 0.031) with BAD group showing more severe impairment. Conclusion. Bipolar depression causes higher global psychosocial impairment than unipolar depression.
    Depression research and treatment 03/2014; 2014:302741. DOI:10.1155/2014/302741
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    • "A diagnosis of major depression using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is made when the following are present: (1) either depressed mood or loss of interest, (2) five or more depressive symptoms co-occurring and persisting over a 2-week period, and (3) functional impairment [2]. Subsyndromal depression has been usually defined as the presence of 2 or more depressive symptoms over a 2-week period and functional impairment and it does not meet the crieteria of major depressive disorder and dysthymia [3], [4]. The term of subsyndromal depression is generally used for milder form of depression than major depressive disorder and risk of it [5]. "
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    ABSTRACT: The purpose of this preliminary study was to test the hypothesis that subsyndromal depression is associated with the volume of medial prefrontal regional gray matter and that of white matter lesions (WMLs) in the brains of cognitively normal older people. We also explored the relationships between subsyndromal depression and medial prefrontal regional gray matter volume, limbic regional gray matter volume, and lobar WMLs in the brains of patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). We performed a cross-sectional study comparing patients with subsyndromal depression and nondepressed controls with normal cognition (n = 59), MCI (n = 27), and AD (n = 27), adjusting for sex, age, years of education, and results of the Mini-Mental State Examination. Frontal WML volume was greater, and right medial orbitofrontal cortical volume was smaller in cognitively normal participants with subsyndromal depression than in those without subsyndromal depression. No volume differences were observed in medial prefrontal, limbic, or WML volumes according to the presence of subsyndromal depression in cognitively impaired patients. The absence of these changes in patients with MCI and AD suggests that brain changes associated with AD pathology may override the changes associated with subsyndromal depression.
    PLoS ONE 01/2014; 9(1):e87747. DOI:10.1371/journal.pone.0087747 · 3.23 Impact Factor
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    • "Likewise, aspects of cognitive impairment are associated with increasing episode frequency (Kessing 1998b; Lebowitz et al. 2001; Lopez-Jaramillo et al. 2010a) leading to lasting psychosocial and work impairment (Dickerson et al. 2004; Wingo et al. 2009). Subsyndromal symptoms may also contribute signifi cantly to long-term disability in individual patients (Coryell et al. 1993; Angst and Preisig 1995; Altshuler et al. 2006; Bonnin et al. 2010) and are a risk factor for the emergence of new mood episodes (Frye et al. 2006). Finally, bipolar disorder is associated with an excess mortality including an increased risk of suicide (Angst et al. 2002; Licht et al. 2008). "
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    ABSTRACT: Abstract Objectives. These guidelines are based on a first edition that was published in 2004, and have been edited and updated with the available scientific evidence up to October 2012. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the long-term treatment of bipolar disorder in adults. Methods. Material used for these guidelines are based on a systematic literature search using various data bases. Their scientific rigor was categorised into six levels of evidence (A-F) and different grades of recommendation to ensure practicability were assigned. Results. Maintenance trial designs are complex and changed fundamentally over time; thus, it is not possible to give an overall recommendation for long-term treatment. Different scenarios have to be examined separately: Prevention of mania, depression, or an episode of any polarity, both in acute responders and in patients treated de novo. Treatment might differ in Bipolar II patients or Rapid cyclers, as well as in special subpopulations. We identified several medications preventive against new manic episodes, whereas the current state of research into the prevention of new depressive episodes is less satisfactory. Lithium continues to be the substance with the broadest base of evidence across treatment scenarios. Conclusions. Although major advances have been made since the first edition of this guideline in 2004, there are still areas of uncertainty, especially the prevention of depressive episodes and optimal long-term treatment of Bipolar II patients.
    The World Journal of Biological Psychiatry 04/2013; 14(3):154-219. DOI:10.3109/15622975.2013.770551 · 4.18 Impact Factor
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