Rethinking the spectrum of mood disorders: Implications for diagnosis and management – Proceedings of a symposium presented at the 30th Annual European College of Neuropsychopharmacology Congress, 4 September 2017, Paris, France

Therapeutic Advances in Psychopharmacology

Volumn 8, Issue 1_suppl, 2018, Pages 1-16

  McIntyre, Roger S ^a   Young, Allan H ^b   Haddad, Peter M ^c  

^a UNIVERSITY OF TORONTO   (Canada)

^b SOUTH LONDON AND MAUDSLEY NHS FOUNDATION TRUST   (United Kingdom)

^c UNIVERSITY OF MANCHESTER   (United Kingdom)

Author keywords

Bipolar disorder; Depression; DSM 5; Hypomania; Mania; Mixed features; Mixed states

Indexed keywords

ANTIDEPRESSANT AGENT; LURASIDONE; NEUROLEPTIC AGENT; VALPROIC ACID; ZIPRASIDONE;

BIPOLAR DISORDER; CLINICAL FEATURE; CLINICAL OUTCOME; CLINICAL PRACTICE; DISEASE COURSE; DRUG EFFICACY; DSM-5; ELECTROCONVULSIVE THERAPY; EVIDENCE BASED PRACTICE; FRANCE; HUMAN; HYPOMANIA; MAJOR DEPRESSION; MOOD DISORDER; PATIENT CARE; PATIENT IDENTIFICATION; PRIORITY JOURNAL; PSYCHOPHARMACOLOGY; REVIEW; SYMPOSIUM; SYMPTOMATOLOGY; TREATMENT RESPONSE;

EID: 85070458896     PISSN: 20451253     EISSN: 20451261     Source Type: Journal    
DOI: 10.1177/2045125318762911     Document Type: Review

References (92)

1. McIntyre RS. Mixed features and mixed states in psychiatry: from calculus to geometry. CNS Spectr 2017; 22: 116–117.
2. Marneros A and Goodwin F (eds) Bipolar disorders: mixed states, rapid cycling and atypical forms. Cambridge: Cambridge University Press, 2005, pp.1–44.
3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Association, 2013.
4. Vieta E and Valentí M. Mixed states in DSM- 5: implications for clinical care, education, and research. J Affect Disord 2013; 148: 28–36.
5. Hu J, Mansur R and McIntyre RS. Mixed specifier for bipolar mania and depression: highlights of DSM-5 changes and implications for diagnosis and treatment in primary care. Prim Care Companion CNS Disord 2014; 16: pii: PCC.13r01599.
6. MacKinnon DF, Zandi PP, Gershon ES, et al. Association of rapid mood switching with panic disorder and familial panic risk in familial bipolar disorder. Am J Psychiatry 2003; 160: 1696–1698.
7. Freedman R, Lewis DA, Michels R, et al. The initial field trials of DSM-5: new blooms and old thorns. Am J Psychiatry 2013; 170: 1–5.
8. McIntyre RS, Soczynska JK, Cha DS, et al. The prevalence and illness characteristics of DSM-5- defined “mixed feature specifier” in adults with major depressive disorder and bipolar disorder: results from the international mood disorders collaborative project. J Affect Disord 2015; 172: 259–264.
9. McIntyre RS, Ng-Mak D, Chuang CC, et al. Major depressive disorder with subthreshold hypomanic (mixed) features: a real-world assessment of treatment patterns and economic burden. J Affect Disord 2017; 210: 332–337.
10. McIntyre RS, Tohen M, Berk M, et al. DSM-5 mixed specifier for manic episodes: evaluating the effect of depressive features on severity and treatment outcome using asenapine clinical trial data. J Affect Disord 2013; 150: 378–383.
11. McIntyre RS. Diagnosing and managing depressive episodes in the DSM-5 era. Curr Psychiatry 2015; 14(Suppl. 10): S1–S8.
12. Fiedorowicz JG, Endicott J, Leon AC, et al. Subthreshold hypomanic symptoms in progression from unipolar major depression to bipolar disorder. Am J Psychiatry 2011; 168: 40–48.
13. Angst J, Cui L, Swendsen J, et al. Major depressive disorder with subthreshold bipolarity in the National Comorbidity Survey Replication. Am J Psychiatry 2010; 167: 1194–1201.
14. Smith DJ, Forty L, Russell E, et al. Sub-threshold manic symptoms in recurrent major depressive disorder are a marker for poor outcome. Acta Psychiatr Scand 2009; 119: 325–329.
15. Zimmermann P, Brückl T, Nocon A, et al. Heterogeneity of DSM-IV major depressive disorder as a consequence of subthreshold bipolarity. Arch Gen Psychiatry 2009; 66: 1341–1352.
16. Balázs J, Benazzi F, Rihmer Z, et al. The close link between suicide attempts and mixed (bipolar) depression: implications for suicide prevention. J Affect Disord 2006; 91: 133–138.
17. Young AH and Eberhard J. Evaluating depressive symptoms in mania: a naturalistic study of patients with bipolar disorder. Neuropsychiatr Dis Treat 2015; 11: 1137–1143.
18. Perugi G, Angst J, Azorin JM, et al.; BRIDGEII- Mix Study Group. Mixed features in patients with a major depressive episode: the BRIDGE-IIMIX study. J Clin Psychiatry 2015; 76: e351–e358.
19. Popovic D, Vieta E, Azorin JM, et al. Suicide attempts in major depressive episode: evidence from the BRIDGE-II-Mix study. Bipolar Disord 2015; 17: 795–803.
20. Goldberg JF, Perlis RH, Ghaemi SN, et al. Adjunctive antidepressant use and symptomatic recovery among bipolar depressed patients with concomitant manic symptoms: findings from the STEP-BD. Am J Psychiatry 2007; 164: 1348–1355.
21. Grunze H, Vieta E, Goodwin GM, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2009 on the treatment of acute mania. World J Biol Psychiatry 2009; 10: 85–116.
22. Grunze H, Vieta E, Goodwin GM, et al.; WFSBP Task Force on Treatment Guidelines for Bipolar Disorders. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. World J Biol Psychiatry 2013; 14: 154–219.
23. Pacchiarotti I, Bond DJ, Baldessarini RJ, et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013; 170: 1249–1262.
24. Goodwin GM, Haddad PM, Ferrier IN, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British association for psychopharmacology. J Psychopharmacol 2016; 30: 495–553.
25. Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15: 1–44.
26. Kennedy SH, Lam RW, McIntyre RS, et al. CANMAT depression work group. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. Pharmacological treatments. Can J Psychiatry 2016; 61: 540–560.
27. McIntyre RS, Suppes T, Tandon R, et al. Florida best practice psychotherapeutic medication guidelines for adults with major depressive disorder. J Clin Psychiatry 2017; 78: 703–713.
28. Akiskal HS, Hantouche EG, Bourgeois ML, et al. Gender, temperament, and the clinical picture in dysphoric mixed mania: findings from a French national study (EPIMAN). J Affect Disord 1998; 50: 175–186.
29. Goldberg JF, Perlis RH, Bowden CL, et al. Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD. Am J Psychiatry 2009; 166: 173–181.
30. Perugi G, Akiskal HS, Micheli C, et al. Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases. J Affect Disord 1997; 43: 169–180.
31. Perugi G, Akiskal HS, Micheli C, et al. Clinical characterization of depressive mixed state in bipolar-I patients: Pisa-San Diego collaboration. J Affect Disord 2001; 67: 105–114.
32. Suppes T, Mintz J, McElroy SL, et al. Mixed hypomania in 908 patients with bipolar disorder evaluated prospectively in the Stanley foundation bipolar treatment network: a sex-specific phenomenon. Arch Gen Psychiatry 2005; 62: 1089–1096.
33. Swann AC, Steinberg JL, Lijffijt M, et al. Continuum of depressive and manic mixed states in patients with bipolar disorder: quantitative measurement and clinical features. World Psychiatry 2009; 8: 166–172.
34. Muneer A. Mixed states in bipolar disorder: etiology, pathogenesis and treatment. Chonnam Med J 2017; 53: 1–13.
35. Rosa AR, Reinares M, Franco C, et al. Clinical predictors of functional outcome of bipolar patients in remission. Bipolar Disord 2009; 11: 401–409.
36. Martin-Carrasco M, Gonzalez-Pinto A, Galan JL, et al. Number of prior episodes and the presence of depressive symptoms are associated with longer length of stay for patients with acute manic episodes. Ann Gen Psychiatry 2012; 11: 7.
37. Akiskal HS, Benazzi F, Perugi G, et al. Agitated “unipolar” depression re-conceptualized as a depressive mixed state: implications for the antidepressant-suicide controversy. J Affect Disord 2005; 85: 245–258.
38. Azorin JM, Baraille L, Gérard S, et al. Mixed states with predominant manic or depressive symptoms: baseline characteristics and 24-month outcomes of the EMBLEM cohort. J Affect Disord 2013; 146: 369–377.
39. De Fazio P, Girardi P, Maina G, et al. Aripiprazole in acute mania and long-term treatment of bipolar disorder: a critical review by an Italian working group. Clin Drug Investig 2010; 30: 827–841.
40. Muneer A. The Treatment of adult bipolar disorder with aripiprazole: a systematic review. Cureus 2016; 8: e562.
41. Haddad PM and Sharma SG. Adverse effects of atypical antipsychotics: differential risk and clinical implications. CNS Drugs 2007; 21: 911–936.
42. Sawyer L, Azorin JM, Chang S, et al. Costeffectiveness of asenapine in the treatment of bipolar I disorder patients with mixed episodes. J Med Econ 2014; 17: 508–519.
43. Sycrest® Summary of product characteristics, http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/001177/WC500096895.pdf (2016, accessed 12 January 2018).
44. Tohen M, McIntyre RS, Kanba S, et al. Efficacy of olanzapine in the treatment of bipolar mania with mixed features defined by DSM-5. J Affect Disord 2014; 168: 136–141.
45. Seroquel® Prescribing information, https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020639s045s046lbl.pdf (2009, accessed 12 January 2018).
46. Seroquel® Summary of product characteristics, https://www.medicines.org.uk/emc/medicine/2295 (2016, accessed 12 January 2018).
47. Suppes T, Ketter TA, Gwizdowski IS, et al. First controlled treatment trial of bipolar II hypomania with mixed symptoms: quetiapine versus placebo. J Affect Disord 2013; 150: 37–43.
48. Vieta E, Suppes T, Ekholm B, et al. Long-term efficacy of quetiapine in combination with lithium or divalproex on mixed symptoms in bipolar I disorder. J Affect Disord 2012; 142: 36–44.
49. Warrington L, Lombardo I, Loebel A, et al. Ziprasidone for the treatment of acute manic or mixed episodes associated with bipolar disorder. CNS Drugs 2007; 21: 835–849.
50. Singh V, Bowden CL and Mintz J. Relative effectiveness of adjunctive risperidone on manic and depressive symptoms in mixed mania. Int Clin Psychopharmacol 2013; 28: 91–95.
51. Macfadden W, Adler CM, Turkoz I, et al. Adjunctive long-acting risperidone in patients with bipolar disorder who relapse frequently and have active mood symptoms. BMC Psychiatry 2011; 11: 171.
52. Latuda® Prescribing information, https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/200603s26s27lbl.pdf (2017, accessed 12 January 2018).
53. Latuda® Summary of product characteristics, https://www.medicines.org.uk/emc/medicine/29125 (2017, accessed 12 January 2018).
54. McIntyre RS, Cucchiaro J, Pikalov A, et al. Lurasidone in the treatment of bipolar depression with mixed (subsyndromal hypomanic) features: post hoc analysis of a randomized placebocontrolled trial. J Clin Psychiatry 2015; 76: 398–405.
55. Swann AC, Bowden CL, Morris D, et al. Depression during mania. Treatment response to lithium or divalproex. Arch Gen Psychiatry 1997; 54: 37–42.
56. Freeman TW, Clothier JL, Pazzaglia P, et al. A double-blind comparison of valproate and lithium in the treatment of acute mania. Am J Psychiatry 1992; 149: 108–111.
57. Clothier J, Swann AC and Freeman T. Dysphoric mania. J Clin Psychopharmacol 1992; 12(Suppl 1): S13–S16.
58. Depakote® Summary of product characteristics, https://www.medicines.org.uk/emc/medicine/25929 (2017, accessed 12 January 2018).
59. Medicines and Healthcare products Regulatory Agency. Valproate and developmental disorders: new alert asking for patient review and further consideration of risk minimisation measures, https://www.gov.uk/drug-safety-update/valproate-and-developmental-disorders-newalert-asking-for-patient-review-and-furtherconsideration-of-risk-minimisation-measures (2017, accessed 12 January 2018).
60. Weisler RH, Hirschfeld R, Cutler AJ, et al.; SPD417 Study Group. Extended-release carbamazepine capsules as monotherapy in bipolar disorder: pooled results from two randomised, double-blind, placebo-controlled trials. CNS Drugs 2006; 20: 219–231.
61. Geddes JR, Calabrese JR and Goodwin GM. Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. Br J Psychiatry 2009; 194: 4–9.
62. Goodwin GM, Bowden CL, Calabrese JR, et al. A pooled analysis of 2 placebo-controlled 18-month trials of lamotrigine and lithium maintenance in bipolar I disorder. J Clin Psychiatry 2004; 65: 432–441.
63. McElroy SL, Weisler RH, Chang W, et al. EMBOLDEN II (Trial D1447C00134) investigators. A double-blind, placebocontrolled study of quetiapine and paroxetine as monotherapy in adults with bipolar depression (EMBOLDEN II). J Clin Psychiatry 2010; 71: 163–174.
64. Viktorin A, Lichtenstein P, Thase ME, et al. The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer. Am J Psychiatry 2014; 171: 1067–1073.
65. Perugi G, Medda P, Toni C, et al. The role of electroconvulsive therapy (ECT) in bipolar disorder: effectiveness in 522 patients with bipolar depression, mixed-state, mania and catatonic features. Curr Neuropharmacol 2017; 15: 359–371.
66. Nusslock R and Frank E. Subthreshold bipolarity: diagnostic issues and challenges. Bipolar Disord 2011; 13: 587–603.
67. Patkar A, Gilmer W, Pae CU, et al. A 6 week randomized double-blind placebo-controlled trial of ziprasidone for the acute depressive mixed state. PLoS One 2012; 7: e34757.
68. Suppes T, Silva R, Cucchiaro J, et al. Lurasidone for the treatment of major depressive disorder with mixed features: a randomized, double-blind, placebo-controlled study. Am J Psychiatry 2016; 173: 400–407.
69. Verdolini N, Agius M, Quartesan R, et al. Mixed states: a “new” nosographic entity. Psychiatr Danub 2014; 26(Suppl 1): 103–111.
70. Zarate CA Jr and Tohen M. Double-blind comparison of the continued use of antipsychotic treatment versus its discontinuation in remitted manic patients. Am J Psychiatry 2004; 161: 169–171.
71. Ahlfors UG, Baastrup PC, Dencker SJ, et al. Flupenthixol decanoate in recurrent manicdepressive illness. A comparison with lithium. Acta Psychiatr Scand 1981; 64: 226–237.
72. Goikolea JM, Colom F, Torres I, et al. Lower rate of depressive switch following antimanic treatment with second-generation antipsychotics versus haloperidol. J Affect Disord 2013; 144: 191–198.
73. Geddes JR, Goodwin GM, Rendell J, et al. BALANCE investigators and collaborators. Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet 2010; 375: 385–395.
74. Jauhar S, McKenna PJ and Laws KR. NICE guidance on psychological treatments for bipolar disorder: searching for the evidence. Lancet Psychiatry 2016; 3: 386–388.
75. Aas M, Henry C, Bellivier F, et al. Affective lability mediates the association between childhood trauma and suicide attempts, mixed episodes and co-morbid anxiety disorders in bipolar disorders. Psychol Med 2017; 47: 902–912.
76. Cattane N, Rossi R, Lanfredi M, et al. Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms. BMC Psychiatry 2017; 17: 221.
77. Carvalho Fernando S, Beblo T, Schlosser N, et al. Associations of childhood trauma with hypothalamic-pituitary-adrenal function in borderline personality disorder and major depression. Psychoneuroendocrinology 2012; 37: 1659–1668.
78. Kim JS and Lee SH. Influence of interactions between genes and childhood trauma on refractoriness in psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70: 162–169.
79. Misiak B and Frydecka D. A history of childhood trauma and response to treatment with antipsychotics in first-episode schizophrenia patients: preliminary results. J Nerv Ment Dis 2016; 204: 787–792.
80. McIntyre RS, Soczynska JK, Liauw SS, et al. The association between childhood adversity and components of metabolic syndrome in adults with mood disorders: results from the international mood disorders collaborative project. Int J Psychiatry Med 2012; 43: 165–177.
81. Ashok AH, Marques TR, Jauhar S, et al. The dopamine hypothesis of bipolar affective disorder: the state of the art and implications for treatment. Mol Psychiatry 2017; 22: 666–679.
82. Mula M, Pini S and Cassano GB. The role of anticonvulsant drugs in anxiety disorders: a critical review of the evidence. J Clin Psychopharmacol 2007; 27: 263–272.
83. Keck PE Jr, Strawn JR and McElroy SL. Pharmacologic treatment considerations in co-occurring bipolar and anxiety disorders. J Clin Psychiatry 2006; 67(Suppl 1): 8–15.
84. Lyrica® Summary of product characteristics, http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000546/WC500046602.pdf (2018, accessed 12 January 2018).
85. Neurontin® Summary of product characteristics, http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Neurontin_30/WC500009308.pdf (2006, accessed 12 January 2018).
86. Salvadore G, Quiroz JA, Machado-Vieira R, et al. The neurobiology of the switch process in bipolar disorder: a review. J Clin Psychiatry 2010; 71: 1488–1501.
87. Ashton H and Young AH. GABA-ergic drugs: exit stage left, enter stage right. J Psychopharmacol 2003; 17: 174–178.
88. Evoy KE, Morrison MD and Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs 2017; 77: 403–426.
89. Van der Loos ML, Mulder PG, Hartong EG, et al.; LamLit Study Group. Efficacy and safety of lamotrigine as add-on treatment to lithium in bipolar depression: a multicenter, double-blind, placebo-controlled trial. J Clin Psychiatry 2009; 70: 223–231.
90. Geddes JR, Gardiner A, Rendell J, et al. CEQUEL investigators and collaborators. Comparative evaluation of quetiapine plus lamotrigine combination versus quetiapine monotherapy (and folic acid versus placebo) in bipolar depression (CEQUEL): a 2 × 2 factorial randomised trial. Lancet Psychiatry 2016; 3: 31–39.
91. Gitlin M. Lithium side effects and toxicity: prevalence and management strategies. Int J Bipolar Disord 2016; 4: 27.
92. Faedda GL, Tondo L, Baldessarini RJ, et al. Outcome after rapid vs gradual discontinuation of lithium treatment in bipolar disorders. Arch Gen Psychiatry 1993; 50: 448–455.