Psychopathological and sociodemographic features in treatment-resistant unipolar depression versus bipolar depression: a comparative study

Nicolas A Nuñez,Stephen Vida,Marie Saint-Laurent,Allan Fielding,Theodore Kolivakis,Pablo Cervantes,Eduard Dumitrescu,Linda Booij,Nancy Low,Stefano Comai,Maykel F Ghabrash,Gabriella Gobbi,John Tabaka

doi:10.1186/s12888-018-1641-y

Abstract

BackgroundSome authors have hypothesized that Treatment-Resistant Unipolar Depression (TRD-UP) should be considered within the bipolar spectrum disorders and that hidden bipolarity may be a risk factor for TRD-UP. However, there are neither studies comparing clinical and sociodemographic data of patients with TRD-UP versus Bipolar (BP) disorders nor are there any examining differences versus Bipolar type I (BP-I) and Bipolar type II (BP-II).MethodsCharts analysis was conducted on 194 patients followed at the Mood Disorders Clinic of the McGill University Health Center. Sociodemographic, clinical features and depression scales were collected from patients meeting DSM-IV criteria for TRD-UP (n = 100) and BP (n = 94). Binary logistic regression analysis was conducted to examine clinical predictors independently associated with the two disorders.ResultsCompared to BP, TRD-UP patients exhibited greater severity of depression, prevalence of anxiety and panic disorders, melancholic features, Cluster-C personality disorders, later onset of depression and fewer hospitalizations. Binary logistic regression indicated that higher comorbidity with anxiety disorders, higher depression scale scores and lower global assessment of functioning (GAF) scores, and lower number of hospitalizations and psychotherapies differentiated TRD-UP from BP patients. We also found that the rate of unemployment and the number of hospitalizations for depression was higher in BP-I than in BP-II, while the rate of suicide attempts was lower in BP-I than in BP-II depressed patients.ConclusionsThese results suggest that TRD-UP constitutes a distinct psychopathological condition and not necessarily a prodromal state of BP depression.

Highlights

Some authors have hypothesized that Treatment-Resistant Unipolar Depression (TRD-UP) should be considered within the bipolar spectrum disorders and that hidden bipolarity may be a risk factor for TRD-UP
While some different characteristics between UP and BP depression have been well characterized, the different demographic, social, and clinical characteristics associated with TRD-UP versus BP depression have not yet been studied, this early differential diagnosis is pivotal for improving diagnostic and therapeutic outcomes. In this retrospective and observational cross-sectional chart-review study, we have examined clinical and demographic characteristics mostly associated with the diagnosis of TRD-UP or BP that have been previously described in the literature as risk factors or predictors for these disorders [14, 16, 24]
Given the subtypes of the bipolar spectrum, we investigated whether there were clinical and socio-demographical characteristics that differed between Bipolar Type I (BP-I) and Type II (BP-II) disorders and between them and TRD-UP

Summary

Introduction

Some authors have hypothesized that Treatment-Resistant Unipolar Depression (TRD-UP) should be considered within the bipolar spectrum disorders and that hidden bipolarity may be a risk factor for TRD-UP. There are neither studies comparing clinical and sociodemographic data of patients with TRD-UP versus Bipolar (BP) disorders nor are there any examining differences versus Bipolar type I (BP-I) and Bipolar type II (BP-II). A number of clinical and demographic characteristics have been found to be associated with TRD-UP. These include comorbidity with anxiety panic disorder, social phobia, personality disorder, suicidal risk, melancholia, number of hospitalizations, recurrent episodes, early age of onset, total number of unresponsive treatments to antidepressants received during a lifetime [13] as well as severity of depression and having a first degree relative with an affective disorder [14]

Methods

Results

Conclusion