Recurrent Unipolar Depression Research Articles

Augmentation with prazosin for patients with depression and a history of trauma: A randomised, double-blind, placebo-controlled study.

Depression with a history of trauma often responds poorly to conventional antidepressants and has a poor prognosis. Prazosin, an α1-adrenoceptor blocker, has shown promise in treating post-traumatic stress disorder symptoms, particularly nightmares. Its potential in treating depression with trauma history warrants investigation. This randomised, double-blind, placebo-controlled study aimed to investigate the efficacy and tolerability of low-dose prazosin (0.5-1 mg/day) as an augmentation strategy in patients with depression and a history of trauma. We sought to determine if prazosin could provide rapid symptom improvement and enhance overall treatment response compared to placebo in this difficult-to-treat patient population. This randomised, double-blind, placebo-controlled clinical study included 59 patients with first-episode or recurrent unipolar or bipolar depression. After basic antidepressant treatment, they were randomly assigned to a prazosin (0.5-1 mg/day) or placebo group for a 6-week double-blind controlled study. The Montgomery-Åsberg Depression Rating Scale, 17-item Hamilton Depression Scale (HAMD-17), and Hamilton Anxiety Scale (HAMA) were used to evaluate efficacy. There were no significant differences in the results of the demographic and clinical symptom assessment between the two groups (p > 0.05). The difference between the HAMD-17 and HAMA scores was statistically significant after 3 days of treatment (p < 0.05). The difference in response rate between the two groups was statistically significant after week 4 of treatment (end of week 4, 56.7% vs. 24.1%, p = 0.011; end of week 6, 80.0% vs. 48.3%, p = 0.011). The incidence of adverse reactions in the prazosin and placebo groups was 20.0% and 24.1%, respectively, with no statistically significant differences (p > 0.05); however, the prazosin group had a lower incidence of sleeplessness or nightmares (3.3% vs. 20.7%, p = 0.039) but a higher incidence of orthostatic hypotension (16.7% vs. 0%, p = 0.007). The severity of orthostatic hypotension was mild to moderate. Low-dose prazosin can effectively improve the emotional symptoms of patients with depression and a history of trauma, and the common adverse reaction is mild-to-moderate orthostatic hypotension. ChiCTR2200063642.

The Relation of Environment to Unipolar Recurrent Depression

IntroductionRecurrent Unipolar and Bipolar affective disorders are considered paradigms of biological entities in psychiatry. However recent theories have underlined the role that environment plays in the genesis of these disorders in interaction with genetic diatheses.ObjectivesThis study examined the relationship between stressful life events (SLE) and recurrent major depressive disorders.MethodsThree groups of 50 subjects were assessed: Patients with recurrent major depressive disorder with melancholic features; patients with borderline personality disorder; and healthy controls. Interviews for DSM-V Disorders were used for diagnosis. Beck Depression Inventory, The Israel Psychiatric Research Interview Life Event Scale and the Coddington Events Schedule were used to measure life events and depression and were confirmed with an interview.ResultsThe proportions of loss-related events in childhood and in the year preceding the first episode was higher in the depressed group than in the control groups during the same time period. Proportions of SLE, uncontrolled and independent events were also more common in the depressed patients in the year preceding the first episode.ConclusionsThe study’s conclusion is that SLE plays an important role in the onset of depressive disorders. There are specific kinds of SLE that occur in childhood and in the year preceding the first episode. SLE has a less significant role in the maintenance of this illness.DisclosureNo significant relationships.

Individualizing Treatment Selection for Pediatric and Adult Patients With Bipolar Depression.

Approximately 60% of patients with bipolar disorder who present with depression are misdiagnosed as having recurrent unipolar depression, which may lead to inappropriate treatment and potential worsening of symptoms. Bipolar depression in youth has a negative effect on numerous domains of life. Early treatment is crucial, yet diagnosis is difficult. The standard of treatment often requires life-long psychopharmacologic management, and treatments have various adverse effects that should be considered when the clinician tailors the regimen for each patient. By facilitating effective communication with patients, referring to diagnostic criteria, and using assessment tools before diagnosis and as treatment continues, clinicians can identify indicators of the disorder, recommend individualized treatment, and help patients work toward greater success in relationships, at home, and at school or work.

Diagnosis and Pharmacotherapy of Bipolar Depression in Adults

Approximately 60% of patients with bipolar disorder (BD) who present with depression are misdiagnosed as having recurrent unipolar depression, which may lead to inappropriate treatment and potential worsening of symptoms. Several factors may interfere with a positive screen and an accurate BD diagnosis-especially substance use disorders. By facilitating effective communication with patients, implementing diagnostic criteria, and using assessment tools, clinicians can accurately identify the often subtle indicators of the disorder and recommend individualized treatment. Whichever pharmacologic is prescribed, it is important to tailor treatment for patients with BD by considering the disease course, potential adverse effects, and comorbidities.

Childhood maltreatment and adult medical morbidity in mood disorders: comparison of unipolar depression with bipolar disorder.

The medical burden in mood disorders is high; various factors are thought to drive this pattern. Little research has examined the role of childhood maltreatment and its effects on medical morbidity in adulthood among people with unipolar depression and bipolar disorder.AimsThis is the first study to explore the association between childhood maltreatment and medical morbidity in bipolar disorder and in unipolar depression, and examine whether the impact of abuse and neglect are distinct or combined. The participants consisted of 354 psychiatrically healthy controls, 248 participants with recurrent unipolar depression and 72 with bipolar disorder. Participants completed the Childhood Trauma Questionnaire and received a validated medical history interview. Any type of childhood maltreatment, child abuse and child neglect were significantly associated with the medical burden in bipolar disorder, but not unipolar depression or for controls. These associations worked in a dose-response fashion where participants with bipolar disorder with a history of two or more types of childhood maltreatment had the highest odds of having a medical illness relative to those without such history or those who reported one form. No such significant dose-response patterns were detected for participants with unipolar depression or controls. These findings suggest that childhood maltreatment may play a stronger role in the development of medical illnesses in individuals with bipolar disorder relative to those with unipolar depression. Individuals who had been maltreated with a mood disorder, especially bipolar disorder may benefit most from prevention and intervention efforts surrounding physical health.Declaration of interestNone.

Resilience in high-risk adolescents of mothers with recurrent depressive disorder: The contribution of fathers

This study examines the role of paternal emotional support as a resilience promoter in offspring of mothers with depression by considering the role of fathers' mental health and the quality of the couple relationship. Two hundred and sixty-five mothers with recurrent unipolar depression, partners and adolescents from Wales were assessed. Paternal emotional support, couple relationship quality, and paternal depression were assessed at baseline; adolescent mental health symptoms were assessed using the Child and Adolescent Psychiatric Assessment at follow-up. Results showed evidence of an indirect pathway whereby couple relationship quality predicted paternal emotional support (β = −.21, 95% CI [−.34, −.08]; p = .002) which in turn predicted adolescent depression (β = −.18, 95% CI [−.33, −.04]; p = .02), but not disruptive behaviours (β = −.08, 95% CI [−.22, .07]; p = .30), after controlling for relevant confounders. The findings highlight that fathers and the broader family system play an important role in enhancing resilience to depression symptoms in at-risk adolescents.

Epigenetics of Metabolic Syndrome as a Mood Disorder.

Mood disorders comprise major depressive disorder (MDD), bipolar disorder (BD) and the milder forms of these two disorders. Reccurring MDD is also known as unipolar disorder. The distinction between unipolar and bipolar disorders was first suggested in 1957 by Leonard and was made official after support by several studies in 1980. Indeed, in 150 AD, Aretaeus of Cappadocia wrote “It seems to me that melancholia is the beginning and a part of mania”. Additionally, Kraepelin, who proposed the first medical disease model in psychiatry a century ago, considered recurrent unipolar depression cases under the category of bipolar disorder and conceptualized spectrum disorders. Because today’s classification systems conduct cross-sectional diagnosis, they do not consider family history, long-term characteristics and multidimensional approaches on symptoms. This method prioritizes reliability over validity and it rules out psychiatric disorders in etiology. Actually, a spectrum model which covers physical diseases is conceivable. The concept of epigenetics considers mood disorders, Alzheimer’s disease, attention deficit and hyperactivity disorder, Carney syndrome, multiple endocrine neoplasia type I and II, breast and prostate cancers, carsinoid tumors, cerebrovascular and cardiovascular diseases and metabolic syndrome together. This review addressed the relationship between metabolic syndrome and mood disorders in this context along with genetic, clinical and environmental factors such as climate, geographic factors, migration and changeable lifestyles. Genetic and clinical variables are affective temperament, childhood trauma and use of antidepressants and antipsychotics.

The Mood Spectrum and Temperamental Instability in Unipolar and Bipolar Disorder.

Background:The current categorical split of mood disorders in bipolar (BP) disorders and depressive disorders has recently been questioned. The presence of a significant number of manic/hypomanic symptoms in patients with recurrent unipolar depression seems to challenge the traditional dichotomy of unipolar-BP disorder. Two highly unstable personality features, i.e., the cyclothymic temperament (CT) and borderline personality disorder, have been found to be more common in BP disorder than in major depressive disorder.Aim:The aim was to assess the distributions of the number of mood spectrum, CT, and borderline personality items between two groups. Finding no bimodal distribution (a “zone of rarity”) of these items would support a continuity between the two disorders.Methods:Forty euthymic BP disorder patients and forty unipolar depression patients were administered the Structured Clinical Interview for the Mood Spectrum, which assesses lifetime symptoms, traits, and lifestyles that characterize threshold and subthreshold mood episodes. CT was assessed using Temperament Evaluation of Memphis, Pisa, Paris and San Diego-A relative to CT and borderline personality trait (BPT) was assessed using Structured Clinical Interview for DSM Disorders II personality questionnaire relative to BPT. The distribution of the number of CT and BPT items was studied by Kernel density estimate.Result:Patient with recurrent depression endorsed manic/hypomanic items though less than BP group. However, the Kernel density estimates distributions of the number of hypomanic/manic items, CT and BPT items in the entire sample had a normal-like shape (i.e. no bimodality).Conclusion:Normal-like curves in the distributions of mood symptoms, number of CT and BPT items in the entire sample, suggest significant amount of overlap of these characteristic in both the groups. Using the bimodality approach, continuity between BP and major depressive disorder (MDD) seems to be supported, questioning the current categorical splitting of BP and MDD based on classic diagnostic validators.

Place of electroconvulsive therapy in the treatment of depression in France: A comparative study between clinical practice and international recommendations

ObjectivesTo study the place of electroconvulsive therapy (ECT) in the treatment of major depressive disorder in France and compare it with international recommendations and algorithms.MethodMulticenter, retrospective study in 12 French university hospitals. Diagnosis, delay between the onset of the episode and the first day of ECT, previous treatments have been identified. Only patients treated for major depressive disorder between 1 January 2009 and 1 January 2014 were included.ResultsA total of 754 patients were included (middle age 61.07 years, sex ratio 0.53). The diagnoses listed were: first major depressive episode (14.95%), bipolar depression (38.85%) and unipolar recurrent depression (46.19%). The delay before ECT, was 11.01 months (13,98), and was significantly longer for first episodes (16.45 months, P &lt; 0.001) and shorter in case of psychotic symptoms (8.76 months, P &lt; 0.03) and catatonic symptoms (6.70, P &lt; 0.01).ConclusionsThe delay before ECT appears on average, four times longer than recommended by treatment algorithms for the management of major depressive disorder. This long delay could be explained by a very heterogeneous access to this treatment in French territory.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The affective pathology in patients with adolescent bulimia nervosa

To investigate affective pathology in patients with adolescent bulimia nervosa (BN) and to analyze comorbid mutual influences of these clinical entities. A sample consisted of 52 young female patients, aged from 13.9 to 17.4 years, who simultaneously meet ICD-10 criteria of F50.2 - typical BN and F30-F39 - mood disorders. The Eating Attitudes Test (EAT-26) and the Beck Depression Inventory were used for psychometric assessment. Duration of follow-up ranged from 1 to 7 years. The common forms of affective disorders comorbid with adolescent BN were dysthymia and bipolar affective disorder (BAD) type II. Less often BN manifested in association with psychogenic endoform depressions. And the less typical was comorbidity of BN with endogenous recurrent unipolar depression. The normalization of mood and transition depression to hypomania contributed to the remission of eating disorders. Worst clinical and social outcome was detected in patients with long-term persistent hypothymia caused by dysthymia or protracted depressive episodes of recurrent depressive disorder. A more favorable outcome was seen in patients with alternation of depression and hypomania in the structure of the BAD type II and the best outcome in patients with single episode of psychogenic endoform depression.

Prevalence and correlates of psychotic experiences amongst children of depressed parents

Psychotic experiences in young people are substantially more common than psychotic disorders, and are associated with distress and functional impairment. Family history of depression as well as of schizophrenia increases risk for psychotic experiences, but the prevalence of such experiences and their clinical relevance in offspring of depressed parents is unknown. Our objectives were to explore i) the prevalence of psychotic experiences amongst offspring of parents with recurrent unipolar depression and ii) the relationship between psychotic experiences and other psychopathology. Data were drawn from the ‘Early Prediction of Adolescent Depression’ longitudinal study of high-risk offspring (aged 9–17 years at baseline) of 337 parents with recurrent depression. Three assessments were conducted over four years. Psychopathology was assessed using the Child and Adolescent Psychiatric Assessment. Seventy-eight percent of families (n=262) had complete data on psychotic experiences at each of the three time points. During the study, 8.4% (n=22; 95% CI 5.0%, 11.8%) of offspring reported psychotic experiences on at least one occasion, and these were associated with psychiatric disorder, specifically mood and disruptive disorders, and suicidal thoughts/behaviour. Psychotic experiences amongst offspring of depressed parents index a range of psychopathology. Further research is needed to examine their clinical significance and long-term consequences.

Liaison psychiatry as a part of a multifocal treatment in a general hospital

We report here three clinical cases as exemples of our rich and frequent collaboration between the department of psychiatry and the department of medecine, nephrology and hemodialysis. This work can serve as a basis for further reflection in order to improve mutual demands. We based our description on three patients chosen for their homogeneity in demand, rapidity of evaluation, the same clinician who evaluated the demand. Either case: a 42-year-old woman, who was admitted for alteration of general state, severe headaches and chronic addiction to alcohool, 71-year-old woman sufferring from recurrent unipolar depression who came for somatic exploration and severe weight loss or 55-year-old man who was transferred from cardio-pulmonary intensive care unit after a volontary ingestion of neuroleptic- were reevaluated by the psychiatrist and the special follow-up was indicated as the patient was discharded from internal medecine department. We were interested in studying how important to the patient this indication turned to be on time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Development, acceptability and efficacy of a standardized healthy lifestyle intervention in recurrent depression

BackgroundResearch evidence on the effects of integrated multifaceted lifestyle interventions for depression is scanty. The aim of the present study is to report on the development, acceptability and efficacy of a standardized healthy lifestyle intervention, including exercise, eating habits, sleep hygiene and smoking cessation in preventing relapses. MethodsOne hundred-sixty outpatients with recurrent unipolar depression or bipolar disorder were recruited after achieving full remission or recovery from the most recent depressive episode. Patients were randomized to 3-months of usual care or to an intervention aimed at promoting a healthy lifestyle (HLI), as an augmentation of pharmacological maintenance treatment. Usual care consisted of clinical management visits. At the end of the intervention, follow-up visits were scheduled at 3,6,9 and 12 months. ResultsDuring the intervention phase, 1 relapse occurred in the HLI group and 4 in the control group. Over the 12 months of follow-up, relapses were 5 in the HLI group and 16 in control group. Using an intent-to-treat approach, the overall percentage of relapses was 6/81 (7.4%) in the HLI group vs. 20/79 (25.3%) in the control group.. In a Kaplan-Meier survival analysis the risk of relapse was significantly lower in patients receiving the HLI intervention (log-rank test, p=0.003) over the 60 weeks of observation.The majority of patients assigned to HLI adhered to the program, and were highly motivated throughout the intervention. LimitationsThe retention rate was low because patients were recruited during the maintenance phase and the 1-year follow-up was relatively short to detect a long-term effect of HLI. ConclusionsThe HLI program proved to be efficacious in preventing relapses. Given the absence of contraindications and its cost-effectiveness in routine practice, the use of HLI should be encouraged to promote the well-being of patients with recurrent depression.

Assessment of first and second degree relatives of individuals with bipolar disorder shows increased genetic risk scores in both affected relatives and young At-Risk Individuals.

Recent studies have revealed the polygenic nature of bipolar disorder (BP), and identified common risk variants associated with illness. However, the role of common polygenic risk in multiplex families has not previously been examined. The present study examined 249 European‐ancestry families from the NIMH Genetics Initiative sample, comparing subjects with narrowly defined BP (excluding bipolar II and recurrent unipolar depression; n = 601) and their adult relatives without BP (n = 695). Unrelated adult controls (n = 266) were from the NIMH TGEN control dataset. We also examined a prospective cohort of young (12–30 years) offspring and siblings of individuals with BPI and BPII disorder (at risk; n = 367) and psychiatrically screened controls (n = 229), ascertained from five sites in the US and Australia and assessed with standardized clinical protocols. Thirty‐two disease‐associated SNPs from the PGC‐BP Working Group report (2011) were genotyped and additive polygenic risk scores (PRS) derived. We show increased PRS in adult cases compared to unrelated controls (P = 3.4 × 10−5, AUC = 0.60). In families with a high‐polygenic load (PRS score ≥32 in two or more subjects), PRS distinguished cases with BPI/SAB from other relatives (P = 0.014, RR = 1.32). Secondly, a higher PRS was observed in at‐risk youth, regardless of affected status, compared to unrelated controls (GEE‐χ2 = 5.15, P = 0.012). This report is the first to explore common polygenic risk in multiplex families, albeit using only a small number of robustly associated risk variants. We show that individuals with BP have a higher load of common disease‐associated variants than unrelated controls and first‐degree relatives, and illustrate the potential utility of PRS assessment in a family context. © 2015 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals, Inc.

Effects of psychiatric history on cognitive performance in old-age depression.

Cognitive deficits in old-age depression vary as a function of multiple factors; one rarely examined factor is long-term psychiatric history. We investigated effects of psychiatric history on cognitive performance in old-age depression and in remitted persons. In the population-based Swedish National Study on Aging and Care in Kungsholmen study, older persons (≥60 years) without dementia were tested with a cognitive battery and matched to the Swedish National Inpatient Register (starting 1969). Participants were grouped according to current depression status and psychiatric history and compared to healthy controls (n = 96). Group differences were observed for processing speed, attention, executive functions, and verbal fluency. Persons with depression and psychiatric inpatient history (n = 20) and late-onset depression (n = 49) performed at the lowest levels, whereas cognitive performance in persons with self-reported recurrent unipolar depression (n = 52) was intermediate. Remitted persons with inpatient history of unipolar depression (n = 38) exhibited no cognitive deficits. Heart disease burden, physical inactivity, and cumulative inpatient days modulated the observed group differences in cognitive performance. Among currently depressed persons, those with inpatient history, and late onset performed at the lowest levels. Importantly, remitted persons showed no cognitive deficits, possibly reflecting the extended time since the last admission (m = 15.6 years). Thus, the present data suggest that cognitive deficits in unipolar depression may be more state- than trait-related. Information on profiles of cognitive performance, psychiatric history, and health behaviors may be useful in tailoring individualized treatment.

Clinical risk factors for weight gain during psychopharmacologic treatment of depression: results from 2 large German observational studies.

Weight gain during psychopharmacologic treatment has considerable impact on the clinical management of depression, treatment continuation, and risk for metabolic disorders. As no profound clinical risk factors have been identified so far, the aim of our analyses was to determine clinical risk factors associated with short-term weight development in 2 large observational psychopharmacologic treatment studies for major depression. Clinical variables at baseline (age, gender, depression psychopathology, anthropometry, disease history, and disease entity) were analyzed for association with percent change in body mass index (BMI; normal range, 18.5 to 25 kg/m(2)) during 5 weeks of naturalistic psychopharmacologic treatment in patients who had a depressive episode as single depressive episode, in the course of recurrent unipolar depression or bipolar disorder according to DSM-IV criteria. 703 patients participated in the Munich Antidepressant Response Signature (MARS) project, an ongoing study since 2002, and 214 patients participated in a study conducted at the University of Muenster from 2004 to 2006 in Germany. Lower BMI, weight-increasing side effects of medication, severity of depression, and psychotic symptoms could be identified as clinical risk factors associated with elevated weight gain during the initial treatment phase of 5 weeks in both studies. Based on these results, a composite risk score for weight gain consisting of BMI ≤ 25 kg/m(2), Hamilton Depression Rating Scale (17-item) score > 20, presence of psychotic symptoms, and administration of psychopharmacologic medication with potential weight-gaining side effects was highly discriminative for mean weight gain (F4,909 = 26.77, P = 5.14E-21) during short-term psychopharmacologic treatment. On the basis of our results, depressed patients with low to normal BMI, severe depression, or psychotic symptoms should be considered at higher risk for weight gain during acute antidepressant treatment. We introduce a new risk score that might be considered in psychopharmacologic decisions for the prevention of weight gain and resulting metabolic disorders.

Poor monitoring of physical health in patients referred to a mood disorders service.

Severe mental illness is associated with significantly increased morbidity and mortality, most commonly from cardiovascular disease. Much of the risk is explicable by potentially modifiable factors such as diabetes and dyslipidaemia, and regular screening of patients with severe mental illness is recommended. Screening and intervention for physical illness among people with schizophrenia is often suboptimal, but little is known about monitoring physical health in patients with affective (mood and anxiety) disorders. Electronic and paper records were examined for evidence of monitoring of cardiovascular disease risk factors in the 12 months prior to assessment in patients attending a tertiary referral specialist service for affective disorders over a period of 39 months. The number of contacts with healthcare services was calculated for each patient to provide an estimate of the opportunities for monitoring. Notes for 113 patients were examined. The mean number of contacts with outpatient services in the 12 months before assessment was 6.9 (standard deviation 7.7). Documented evidence of physical-health monitoring was seen in only 29 patients: monitoring was more commonly undertaken in patients with recurrent unipolar depression and in those who had undergone recent inpatient treatment. Contacts that could have allowed monitoring of physical health were common. Although most patients had multiple contacts with health services in the 12-month period before their assessment in the service, there was little evidence of use of primary-prevention measures to reduce the risks of diabetes and cardiovascular disease in this vulnerable population.

P.2.b.044 Remission of recurrent unipolar depression: clinical types and impact of personality disorders

with physical inactivity in hypertensive females (AOR, 1.45; 95%CI, 1.03–2.04;P = 0.03) but not in hypertensive males (AOR, 1.15; 95%CI, 0.76–1.74;P = 0.5). The likelihood of smoking and physical inactivity significantly increased with increasing depressive symptoms severity (AOR, 1.26; 95%CI, 1.003–1.58;P = 0.04 for smoking, and AOR, 1.60; 95%CI, 1.34–1.91;P< 0.001 for physical inactivity). Conclusions: Depressive symptoms in hypertensive persons are associated with smoking and lack of physical activity with a differential effect of gender.

Lithium in the treatment of major depressive disorder.

Recent high-quality studies have confirmed the central role of lithium in the treatment of bipolar disorder and have established lithium as the drug of first choice for long-term prophylaxis in this condition. However, several indications for its use in unipolar major depression are also based on sound evidence. This includes lithium augmentation as a main strategy for depressed patients not responding to an antidepressant, lithium prophylaxis for recurrent unipolar depression as an alternative to prophylaxis with an antidepressant, and lithium's unique anti-suicidal properties. Lithium monotherapy, on the other hand, is not established for acute treatment of depression. Lithium therapy should be a core competency of every psychiatrist, enabling the safe use of lithium, to the benefit of our patients.

EPA-1049 – Painful physical symptoms: is there a difference between bipolar and unipolar depression

Depression and pain symptoms are often comorbid and share common neurobiological and psychological background. To find out the prevalence of painful physical symptoms (PPS) in otherwise healthy patients hospitalized due to recurrent unipolar (UD) and bipolar depression (BD) and to compare socio-demographic and illness related characteristics. 180 somatically healthy patients were recruited in the study. Symptoms of depression were evaluated with standard clinical tools. The presence of somatic illness was excluded. Visual Analogue Scale was used to evaluate the intensity and location of painful symptoms. Sociodemographic, illness and therapy related data, substance use, and suicidality were recorded as well. 41 patients met criteria for BD and 139 for UD. The average age was 50 years (75% females). Higher prevalence of PPS in group of UD (72.6%) in comparison to BD (58.5%) was found. The average intensity of painful symptoms was high. Patients with UD+PPS had higher total number of PPS and scored higher on HAM-D 21 and Zung Self Rating Depression Scale than patients with BD+PPS. Use of analgesics and anxiolytics was high. The study offers an insight in the high prevalence of PPS in patients with acute severe unipolar and bipolar depression and the results warn of possible over prescribing of analgesics and anxiolytics. Lower prevalence of PPS in BD might be explained with less severe depression symptoms. The results offer new information on PPS in acute bipolar depression since there is very little research data on this topic.