Rates and predictors of developing a manic or hypomanic episode 1 to 2 years following a first hospitalization for major depression with psychotic features.
BACKGROUND
Although the presence of psychosis during major depression has been identified as a predictor of later developing mania or hypomania, to our knowledge there have been no studies examining rates and predictors of developing a manic or hypomanic episode in patients who were admitted for their first psychiatric hospitalization for major depressive disorder with psychosis (MDDP).


METHODS
Patients admitted for their first psychiatric hospitalization, with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) diagnosis of MDDP, were recruited from three sites (N = 157) and evaluated prospectively for up to 2 years to identify new symptoms of mania or hypomania. Family history was assessed using the Family History-Research Diagnostic Criteria Interview. Clinical and demographic factors associated with developing a manic or hypomanic episode were identified using stepwise logistic regression.


RESULTS
Thirteen percent (n = 21) of patients with MDDP developed mania or hypomania within the follow-up period. Family history of affective disorders and age at onset of MDDP were not predictive of switch. MDDP patients who were treated with antidepressants were four times less likely to develop mania or hypomania than those who were not treated with antidepressants, after controlling for site differences.


CONCLUSIONS
Our findings suggest that within the first 1 to 2 years following first hospitalization for MDDP, a subset of patients will develop mania or hypomania. Additionally, our data suggest that antidepressant exposure does not increase the risk of, and may be protective against, developing a manic or hypomanic episode in patients hospitalized for MDDP.
DelBello
Melissa P
MP
The Bipolar and Psychotic Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0559, USA. delbelmp@email.uc.edu
Carlson
Gabrielle A
GA
Tohen
Mauricio
M
Bromet
Evelyn J
EJ
Schwiers
Michael
M
Strakowski
Stephen M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D016009:Chi-Square Distribution; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology*; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data / Q000639:trends; D016019:Survival Analysis
D000928:Antidepressive Agents