title: Does psychomotor agitation in major depressive episodes indicate bipolarity? Evidence from the Zurich Study.
abstract: BACKGROUND
  Kraepelin's partial interpretation of agitated depression as a mixed state of "manic-depressive insanity" (including the current concept of bipolar disorder) has recently been the focus of much research. This paper tested whether, how, and to what extent both psychomotor symptoms, agitation and retardation in depression are related to bipolarity and anxiety.
  
  
  METHODS
  The prospective Zurich Study assessed psychiatric and somatic syndromes in a community sample of young adults (N = 591) (aged 20 at first interview) by six interviews over 20 years (1979-1999). Psychomotor symptoms of agitation and retardation were assessed by professional interviewers from age 22 to 40 (five interviews) on the basis of the observed and reported behaviour within the interview section on depression. Psychiatric diagnoses were strictly operationalised and, in the case of bipolar-II disorder, were broader than proposed by DSM-IV-TR and ICD-10. As indicators of bipolarity, the association with bipolar disorder, a family history of mania/hypomania/cyclothymia, together with hypomanic and cyclothymic temperament as assessed by the general behavior inventory (GBI) [15], and mood lability (an element of cyclothymic temperament) were used.
  
  
  RESULTS
  Agitated and retarded depressive states were equally associated with the indicators of bipolarity and with anxiety. Longitudinally, agitation and retardation were significantly associated with each other (OR = 1.8, 95% CI = 1.0-3.2), and this combined group of major depressives showed stronger associations with bipolarity, with both hypomanic/cyclothymic and depressive temperamental traits, and with anxiety. Among agitated, non-retarded depressives, unipolar mood disorder was even twice as common as bipolar mood disorder.
  
  
  CONCLUSIONS
  Combined agitated and retarded major depressive states are more often bipolar than unipolar, but, in general, agitated depression (with or without retardation) is not more frequently bipolar than retarded depression (with or without agitation), and pure agitated depression is even much less frequently bipolar than unipolar. The findings do not support the hypothesis that agitated depressive syndromes are mixed states.
  
  
  CONCLUSIONS
  The results are limited to a population up to the age of 40; bipolar-I disorders could not be analysed (small N).
authors.affiliation: Psychiatric Hospital, Zurich University, Lenggstrasse 31, P.O. Box 1931, 8032 Zurich, Switzerland. jangst@bli.uzh.ch
authors.forename: Jules
authors.initials: J
authors.lastname: Angst
authors.forename: Alex
authors.initials: A
authors.lastname: Gamma
authors.forename: Franco
authors.initials: F
authors.lastname: Benazzi
authors.forename: Vladeta
authors.initials: V
authors.lastname: Ajdacic
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D003527:Cyclothymic Disorder / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult