An approach to revealing clinically relevant subgroups across the mood spectrum.
Individuals diagnosed with bipolar 1 disorder (BP1), bipolar 2 disorder (BP2), or major depressive disorder (MDD) experience varying levels of depressive and (hypo)manic symptoms. Clarifying symptom heterogeneity is meaningful, as even subthreshold symptoms may impact quality of life and treatment outcome. The MOODS Lifetime self-report instrument was designed to capture the full range of depressive and (hypo)manic characteristics.



This study applied clustering methods to 347 currently depressed adults with MDD, BP2, or BP1 to reveal naturally occurring MOODS subgroups. Subgroups were then compared on baseline clinical and demographic characteristics and as well as depressive and (hypo)manic symptoms over twenty weeks of treatment.



Four subgroups were identified: (1) high depressive and (hypo)manic symptoms (N=77, 22%), (2) moderate depressive and (hypo)manic symptoms (N=115, 33%), (3) low depressive and moderate (hypo)manic symptoms (N=82, 24%), and (4) low depressive and (hypo)manic symptoms (N=73, 21%). Individuals in the low depressive/moderate (hypo)manic subgroup had poorer quality of life and greater depressive symptoms over the course of treatment. Individuals in the high and moderate severity subgroups had greater substance use, longer duration of illness, and greater (hypo)manic symptoms throughout treatment. Treatment outcomes were primarily driven by individuals diagnosed with MDD.



The sample was drawn from three randomized clinical trials. Validation is required for this exploratory study.



After validation, these subgroups may inform classification and personalized treatment beyond categorical diagnosis.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States; Department of Statistics, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: lotzmj@upmc.edu.
Meredith L
ML
Wallace
Department of Statistics, University of Pittsburgh, Pittsburgh, PA, United States.
Burcin
B
Simsek
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
David J
DJ
Kupfer
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
Holly A
HA
Swartz
Department of Molecular Medicine, University of Siena, Italy.
Andrea
A
Fagiolini
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
Ellen
E
Frank
D000328:Adult; D000339:Affect; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D055815:Young Adult
Bipolar disorder; Cluster; Dimensional construct; Major depressive disorder; Mood severity; Subtype