title: Course of illness following prospectively observed mania or hypomania in individuals presenting with unipolar depression.
abstract: OBJECTIVE
  In a well-defined sample, we sought to determine which clinical variables, some of potential nosological relevance, influence subsequent course following prospectively observed initial episodes of hypomania or mania (H/M).
  
  
  METHODS
  We identified 108 individuals in the National Institute of Mental Health Collaborative Depression Study diagnosed with unipolar major depression at intake who subsequently developed H/M. We assessed time to repeat H/M based on whether one had been started on an antidepressant or electroconvulsive therapy within eight weeks of developing H/M, had longer episodes, or had a family history of bipolar disorder.
  
  
  RESULTS
  Modeling age of onset, treatment-associated H/M, family history of bipolar disorder, duration of index H/M episode, and psychosis in Cox regression analysis, family history of bipolar disorder (n=21) was strongly associated with repeat episodes of H/M [hazard ratio (HR)=2.01, 95% confidence interval (CI): 1.06-3.83, p=0.03]. Those with treatment-associated episodes (n=12) were less likely to experience subsequent episodes of H/M, although this was not significant in the multivariate model (HR=0.25, 95% CI: 0.06-1.05, p=0.06). These individuals also had a later age of onset for affective illness and were more likely to be depressed. Duration of illness with a temporal resolution of one week, psychosis, and age of onset were not associated with time to repeat H/M episode.
  
  
  CONCLUSIONS
  A family history of bipolar disorder influences the course of illness, even after an initial H/M episode. In this select sample, treatment-associated H/M did not appear to convey the same risk for a course of illness characterized by recurrent H/M episodes.
authors: Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, W278GH Iowa City, IA 52242, USA. jess-fiedorowicz@uiowa.edu
authors: Jess G
authors: JG
authors: Fiedorowicz
authors: Jean
authors: J
authors: Endicott
authors: David A
authors: DA
authors: Solomon
authors: Martin B
authors: MB
authors: Keller
authors: William H
authors: WH
authors: Coryell
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000209:etiology / Q000503:physiopathology*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents