The DOI matches its Crossref record; 41 of the 41 references it cites were found in a registry or an index.
Manic Symptoms During Depressive Episodes in 1,380 Patients With Bipolar Disorder: Findings From the STEP-BD
Open accessAbstract
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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 ( CANMAT ) and International Society for Bipolar Disorders ( ISBD ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [317]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962
(1998) · PubMed · Cited by 10,216
A Rating Scale for Mania: Reliability, Validity and Sensitivity
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978) · British Journal of Psychiatry · doi:10.1192/bjp.133.5.429 · Cited by 8,744
Spitzer, R. L. (1978) · Archives of General Psychiatry · doi:10.1001/archpsyc.1978.01770300115013 · Cited by 6,946
Manic-Depressive Insanity and Paranoia.
(1921) · JAMA · doi:10.1001/jama.1921.02630330070026 · Cited by 1,612
Extending Indications for Long-Term Pharmacotherapy: Opportunities and Challenges
Kane, J. M. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.1.1 · Cited by 989
Hirschfeld, R. M. A., Lewis, L., & Vornik, L. A. (2003) · PubMed · Cited by 943
Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression
Sachs, G. S., Nierenberg, A. A., Calabrese, J. R., Marangell, L. B., Wisniewski, S. R., Gyulai, L., Friedman, E. S., Bowden, C. L., Fossey, M. D., Ostacher, M. J., et al. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa064135 · Cited by 937
Self-citationHirschfeld, R. M. A., Lewis, L., & Vornik, L. A. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0209 · Cited by 922
Perlis, R. H., Ostacher, M. J., Patel, J. K., Marangell, L. B., Zhang, H., Wisniewski, S. R., Ketter, T. A., Miklowitz, D. J., Otto, M. W., Gyulai, L., et al. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.2.217 · Cited by 689
Self-citationSachs, G. S., Thase, M. E., Otto, M. W., Bauer, M. S., Miklowitz, D. J., Wisniewski, S. R., Lavori, P. W., Lebowitz, B. D., Rudorfer, M., Frank, E., et al. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(03)00165-3 · Cited by 532
Self-citationClinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania
McElroy, S. L., Keck, P. E., Pope, H. G., Hudson, J. I., Faedda, G. L., & Swann, A. C. (1992) · American Journal of Psychiatry · doi:10.1176/ajp.149.12.1633 · Cited by 428
Nemeroff, C. B., Evans, D. L., Gyulai, L., Sachs, G. S., Bowden, C. L., Gergel, I. P., Oakes, R., & Pitts, C. D. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.6.906 · Cited by 406
Self-citationAGITATED DEPRESSION AS A MIXED STATE AND THE PROBLEM OF MELANCHOLIA
Koukopoulos, A., & Koukopoulos, A. (1999) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(05)70095-2 · Cited by 310
Practice guideline for the treatment of patients with bipolar disorder (revision).
(2002) · PubMed · Cited by 276
Antidepressant Treatment in Bipolar Versus Unipolar Depression
Ghaemi, S. N., Rosenquist, K. J., Ko, J. Y., Baldassano, C. F., Kontos, N. J., & Baldessarini, R. J. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.1.163 · Cited by 271
Clinical Practice Guidelines for Bipolar Disorder From the Department of Veterans Affairs
Bauer, M. S., Callahan, A. M., JAMPALA, C. V., Petty, F., Sajatovic, M., Schaefer, V., Wittlin, B., & Powell, B. J. (1999) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v60n0104 · Cited by 268
Bipolar disorder—focus on bipolar II disorder and mixed depression
Benazzi, F. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60453-x · Cited by 236
Goldberg, J. F., Perlis, R. H., Ghaemi, S. N., Calabrese, J. R., Bowden, C. L., Wisniewski, S. R., Miklowitz, D. J., Sachs, G. S., & Thase, M. E. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.05122032 · Cited by 215
Self-citationYoung, L. T., Joffe, R. T., Robb, J. C., MacQUEEN, G. M., MARRIOTT, M. J., & Patelis‐Siotis, I. (2000) · American Journal of Psychiatry · doi:10.1176/ajp.157.1.124 · Cited by 211
Bipolar depression: phenomenological overview and clinical characteristics
Mitchell, P. B., & Malhi, G. S. (2004) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00137.x · Cited by 210
Suppes, T., Mintz, J., McElroy, S. L., Altshuler, L. L., Kupka, R. W., Frye, M. A., Keck, P. E., Nolen, W. A., Leverich, G. S., Grunze, H., et al. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.10.1089 · Cited by 209 · cited 2×
“(15) studied simultaneous hypomanic and depressive features (“mixed hypomania”), operationally defined on the basis of thresholds on the severity scales of the Young Mania Rating Scale (16) and Inventory of Depressive Symptomatology—Clinician-”
Hendrick, V. C., Altshuler, L. L., Gitlin, M. J., Delrahim, S., & Hammen, C. L. (2000) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v61n0514 · Cited by 182
International Classification of Diseases
Lutz, R., Kleva, C. S., & Keeley, J. W. (2024) · doi:10.4135/9781071886229.n237 · Cited by 165
Agitated Depression in Bipolar I Disorder: Prevalence, Phenomenology, and Outcome
Maj, M., Pirozzi, R., Magliano, L., & Bartoli, L. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.12.2134 · Cited by 146
Melancholia agitata and mixed depression
Koukopoulos, A., Sani, G., Koukopoulos, A., Manfredi, G., Pacchiarotti, I., & Girardi, P. (2007) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2007.00963.x · Cited by 138
Irritable-hostile depression: further validation as a bipolar depressive mixed state
Benazzi, F., & Akiskal, H. S. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2004.07.006 · Cited by 130
Kogan, J. N., Otto, M. W., Bauer, M. S., Dennehy, E. B., Miklowitz, D. J., Zhang, H., Ketter, T. A., Rudorfer, M. V., Wisniewski, S. R., Thase, M. E., et al. (2004) · Bipolar Disorders · doi:10.1111/j.1399-5618.2004.00158.x · Cited by 121
Self-citationAssociation of Recurrent Suicidal Ideation With Nonremission From Acute Mixed Mania
Goldberg, J. F., Garno, J. L., Leon, A. C., Kocsis, J. H., & S, L. P. M. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.12.1753 · Cited by 114
Self-citationDevelopment of the Bipolar Inventory of Symptoms Scale
Bowden, C. L., Singh, V., Thompson, P., Gonzalez, J. M., Katz, M. M., Dahl, M., Prihoda, T. J., & Chang, X. (2006) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2006.00955.x · Cited by 94
Self-citationIDS-C and IDS-SR: Psychometric properties in depressed in-patients
Corruble, E., Legrand, J. M., Duret, C., Charles, G., & Guelfi, J. D. (1999) · Journal of Affective Disorders · doi:10.1016/s0165-0327(99)00055-5 · Cited by 89
Sleep EEG and DST findings in anergic bipolar depression
Thase, M. E., Himmelhoch, J. M., Mallinger, A. G., Db, J., & Kupfer, D. J. (1989) · American Journal of Psychiatry · doi:10.1176/ajp.146.3.329 · Cited by 74
Self-citationThe clinical epidemiology of pure and mixed manic episodes
Cassidy, F., & Carroll, B. J. (2001) · Bipolar Disorders · doi:10.1034/j.1399-5618.2001.030105.x · Cited by 68
The role of gender in mixed mania
Arnold, L. M., McElroy, S. L., & Keck, P. E. (2000) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(00)90137-8 · Cited by 64
Reviewing the diagnostic validity and utility of mixed depression (depressive mixed states)
Benazzi, F. (2007) · European Psychiatry · doi:10.1016/j.eurpsy.2007.07.003 · Cited by 61
Evaluating the inter-episode stability of depressive mixed states
SATO, T. (2003) · Journal of Affective Disorders · doi:10.1016/s0165-0327(03)00159-9 · Cited by 60
Koukopoulos, A., & Tundo, A. (1992) · Clinical Neuropharmacology · doi:10.1097/00002826-199201001-00324 · Cited by 53
Psychometric delineation of the most discriminant symptoms of depressive mixed states
Benazzi, F., & Akiskal, H. S. (2005) · Psychiatry Research · doi:10.1016/j.psychres.2005.07.024 · Cited by 45
Perlis, R. H., Purcell, S., Fagerness, J. A., Cusin, C., Yamaki, L. H., D, M. F. M., & Smoller, J. W. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.10.034 · Cited by 44
Self-citationPresence of Irritability During Depressive Episodes in Bipolar Disorder
Deckersbach, T., Perlis, R. H., Frankle, W. G., Gray, S. M., Sylvia, L. G., Dougherty, D. D., Nierenberg, A. A., & Sachs, G. S. (2004) · CNS Spectrums · doi:10.1017/s1092852900009020 · Cited by 43
Self-citation
Flagged first, then by citations
Research works printed but not linked: 2
- Sheehan D, 1998, J Clin Psychiatry, 59, 22
- American Psychiatric Association, 2002, Am J Psychiatry, 159
Cited by
Sorted by citations
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., et al. (2018) · Bipolar Disorders · doi:10.1111/bdi.12609 · Cited by 1,852
Self-citationYatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Beaulieu, S., Alda, M., O’Donovan, C., MacQUEEN, G. M., McIntyre, R. S., Sharma, V., et al. (2012) · Bipolar Disorders · doi:10.1111/bdi.12025 · Cited by 1,230
Pacchiarotti, I., Bond, D. J., Baldessarini, R. J., Nolen, W. A., Grunze, H., Licht, R. W., Post, R. M., Berk, M., Goodwin, G. M., Sachs, G. S., et al. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.13020185 · Cited by 770
Self-citationAshok, A. H., Marques, T. R., Jauhar, S., Nour, M. M., Goodwin, G. M., Young, A. H., & Howes, O. D. (2017) · Molecular Psychiatry · doi:10.1038/mp.2017.16 · Cited by 546
Angst, J. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.87 · Cited by 414
Metadata
- 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 (medical) › 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
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
