title: Symptom characteristics of depressive episodes prior to the onset of mania or hypomania.
abstract: OBJECTIVE
  Depressive episodes are typically the initial presentation of bipolar disorder. The evidence as to whether depressive episodes occurring in persons who later convert to bipolar disorder are symptomatically distinct from episodes of unipolar depression remains controversial. As there are crucial differences in the therapeutic management, symptom profiles indicating subsequent bipolar conversion may aid in appropriate treatment.
  
  
  METHODS
  A representative community sample of originally N = 3021 adolescents and young adults aged 14-24 years at baseline was assessed up to four times over 10 years. Assessment of symptoms was conducted by clinically trained interviewers using the standardized M-CIDI. Symptom profiles of depressive episodes were compared via logistic regression between subjects that subsequently developed (hypo-)manic episodes (n = 35) or remained unipolar depressive (n = 659).
  
  
  RESULTS
  Initial depression amongst prospective converters was characterized by significantly increased suicidality (odds ratio, OR = 2.31), higher rates of feelings of worthlessness and excessive guilt (OR = 2.52), complete loss of pleasure (OR = 2.53) and diurnal variation (OR = 4.30). No differences were found for hyperphagia, hypersomnia and psychomotor alterations.
  
  
  CONCLUSIONS
  Findings suggest that the symptom profile of initial depressive episodes may be useful in the identification of subjects with an elevated risk for the subsequent conversion to bipolar disorder.
authors.affiliation: Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Pfennig
authors.affiliation: Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: P S
authors.initials: PS
authors.lastname: Ritter
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Höfler
authors.affiliation: Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany.|Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Lieb
authors.affiliation: Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.|Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany.
authors.forename: H-U
authors.initials: HU
authors.lastname: Wittchen
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.|Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Beesdo-Baum
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D013405:Suicide / Q000706:statistics & numerical data; D055815:Young Adult
keywords: bipolar disorder; early manifestation; early recognition; unipolar depression