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15-03-2011 | Mental health | Article

Cyclothymic features in depression pose risk for bipolarity


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MedWire News: Patients with recurrent depressive disorder (RDD) who score highly on measures of cyclothmic temperament (CT) frequently display risk factors for bipolarity such as early age at first depressive episode and suicidal ideation, study results show.

Given that of bipolar disorder is often underdiagnosed, CT screening should therefore be considered in those presenting with in RDD, say Anwar Mechri (Hospital of Monastir, Tunisia) and colleagues comment.

"A misdiagnosis of unipolar depression rather than bipolar depression can lead to inappropriate treatments, such as antidepressants as monotherapy (ie, not combined with mood stabilizers) which in patients with bipolar depression may not only be less effective but also have an increased risk of a manic switch or cycle acceleration," they comment in the Journal of Affective Disorders.

In response, several studies have been carried-out to identify predictive factors of bipolarity in depressive disorders.

The main clinical factors correlated with bipolarity so far are a family history of bipolar, young age at onset, a high number of depressive episodes, a puerperal depression, presence of psychotic features, hypersomnia, and psychomotor inhibition or agitation.

In addition affective temperaments, especially cyclothymic and hyperthymic may be important but have rarely been assessed.

For the current study the researchers recruited 98 patients with a diagnosis of RDD. CT was assessed using the Tunisian version of the TEMPS cyclothymic subscale, using a threshold score of 10 (of a maximum 21) to denote CT pathology (CT+). All patients were assessed by means of a semi-structured questionnaire, based on illness history, psychiatric, and medical examination and available documentation.

Mechri et al report that the average CT score was 6.5 and around one-third (33.7%) of patients had a CT score of 10 or more (forming the CT+ group).

Patients in the CT+ group had significantly earlier onset age than those in the CT- group (first episode before 25 years: 36.3% versus 9.2%), as well as a greater number of previous depressive episodes (6.4 vs 3.9), previous hospitalizations (2.1 vs 0.9), and number of previous suicide attempts (0.7 vs 0.2).

Furthermore, in the CT+ group, the most recent depressive episode was more often severe than in the CT- group (78.7% vs 35.3%) and with more frequently psychotic features (54.5% vs 6.1%) and melancholic features (39.3% vs 12.3%).

However, age, gender, postpartum onset of the first depressive episode and seasonality of depressive recurrences did not significantly differ between the two groups.

"These results confirm that CT should be included in the bipolar spectrum and suggest the relevance of this temperament screening in recurrent depressive patients," Mechri and team comment.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Andrew Czyzewski

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