title: Depression symptom ratings in geriatric patients with bipolar mania.
abstract: OBJECTIVE
  Given the paucity of information available regarding standardized ratings of depression symptoms in bipolar manic states, and in particular those in older adults, we explored depression ratings in symptomatic participants in a multicenter study of treatment of bipolar I disorder in late life.
  
  
  METHODS
  Baseline data was obtained from the first 100 patients enrolled in an NIMH-funded, 9-week, randomized, double-blind RCT comparing treatment with lithium or valproate in patients of age 60 years and older with Type I Bipolar mania or hypomania. This multi-site study was conducted at six academic medical centers in the United States and enrolled inpatients and outpatients with a total Young Mania Rating Scale (YMRS) score of 18 or greater. Depressive symptoms were evaluated with the Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS). The criterion for at least moderate bipolar depressive symptoms was the European College of Neuropsychopharmacology (ECNP) Consensus Meeting definition of HAM-D 17 total score >20.
  
  
  RESULTS
  Eleven percent of patients had mixed symptoms defined by depression scale severity according to ECNP criterion. In the overall sample, total scores on the two depression scales were highly correlated. Total YMRS scores of this mixed symptom group were similar to the remainder of the sample.
  
  
  CONCLUSIONS
  These preliminary findings suggest that moderate to severe depressive symptoms occur in about one in ten bipolar manic elders. Future studies are needed to further evaluate symptom profiles, clinical correlates, and treatments for bipolar older adults with combined manic and depressive symptoms.
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA. martha.sajatovic@uhhospitals.org
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
authors.forename: Rayan
authors.initials: R
authors.lastname: Al Jurdi
authors.forename: Ariel
authors.initials: A
authors.lastname: Gildengers
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Greenberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Tenhave
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
authors.forename: Benoit
authors.initials: B
authors.lastname: Mulsant
authors.forename: Robert C
authors.initials: RC
authors.lastname: Young
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000523:psychology*; D003866:Depressive Disorder / Q000209:etiology* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D005852:Geriatric Psychiatry; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D014481:United States; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D018692:Antimanic Agents; D014635:Valproic Acid; D008094:Lithium