Manic Symptoms During Depressive Episodes in 1,380 Patients With Bipolar Disorder: Findings From the STEP-BD
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OBJECTIVE: Little is known about how often bipolar depressive episodes are accompanied by subsyndromal manic symptoms in bipolar I and II disorders. The authors sought to determine the frequency and clinical correlates of manic symptoms during episodes of bipolar depression. METHOD: From among 4,107 enrollees in the National Institute of Mental Health's Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), 1,380 individuals met criteria for bipolar I or II depressive syndromes at the time of enrollment and were assessed for concomitant manic symptoms. Illness characteristics were compared in patients with pure bipolar depressed episodes and those with mixed depressive presentations. RESULTS: Two-thirds of the subjects with bipolar depressed episodes had concomitant manic symptoms, most often distractibility, flight of ideas or racing thoughts, and psychomotor agitation. Patients with any mixed features were significantly more likely than those with pure bipolar depressed episodes to have early age at illness onset, rapid cycling in the past year, bipolar I subtype, history of suicide attempts, and more days in the preceding year with irritability or mood elevation. CONCLUSIONS: Manic symptoms often accompany bipolar depressive episodes but may easily be overlooked when they appear less prominent than depressive features. Subsyndromal manic symptoms during bipolar I or II depression demarcate a more common, severe, and psychopathologically complex clinical state than pure bipolar depression and merit recognition as a distinct nosologic entity.
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Many patients with bipolar depression will also experience at least subsyndromal hypomanic or manic features, and this presentation is associated with more severe depressive symptoms, as well as a higher rate of substance use and cardiovascular disease.
“Many patients with bipolar depression will also experience at least subsyndromal hypomanic or manic features, and this presentation is associated with more severe depressive symptoms, as well as a higher rate of substance use and cardiovascular disease.317”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [317]
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- Authors
- Goldberg, J. F., Perlis, R. H., Bowden, C. L., Thase, M. E., Miklowitz, D. J., Marangell, L. B., Calabrese, J. R., Nierenberg, A. A., & Sachs, G. S.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Venue
- American Journal of Psychiatry
- Published
- 2009-02
- Volume
- 166
- Issue
- 2
- Pages
- 173-181
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC10034853
- OpenAlex
- W2136900530
- Cited by
- 322
- References
- 41
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 2 · 2023: 12 · 2022: 8 · 2021: 12 · 2020: 18 · 2019: 19 · 2018: 12 · 2017: 25 · 2016: 32 · 2015: 24 · 2014: 25 · 2013: 20 · 2012: 35
- FWCI
- 18.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Defense
- American Psychiatric Publishing
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Jazz Pharmaceuticals
- Supernus Pharmaceuticals
- Dainippon Sumitomo Pharma
- Servier
- National Institutes of Health (n01mh80001-12-0-0, 1k23mh001936-01a1)
- National Institute of Mental Health (K23 MH-01936, N01-MH80001, N01 MH080001)
- UCB Pharma
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- bipolar depression, mixed features, bipolar I disorder, bipolar II disorder, distractibility, flight of ideas, psychomotor agitation, rapid cycling, age of onset, suicide attempts, irritability, mood improvement, disease classification
- MeSH terms
- Adult, Affect, Antidepressive Agents, Bipolar Disorder, Cross-Sectional Studies, Major Depressive Disorder, Diagnosis, Differential, Euphoria, Female, Humans, Irritable Mood, Longitudinal Studies, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Treatment Outcome, Antimanic Agents, Diagnostic and Statistical Manual of Mental Disorders
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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