Predictors of the onset of manic symptoms and a (hypo)manic episode in patients with major depressive disorder

L. Boschloo, A.T. Spijker, E. Hoencamp, R.W. Kupka, W.A. Nolen, R.A. Schoevers, B.W.J.H. Penninx

    Research output: Contribution to JournalArticleAcademicpeer-review

    Abstract

    OBJECTIVE: One third of patients with a major depressive episode also experience manic symptoms or, even, a (hypo)manic episode. Retrospective studies on the temporal sequencing of symptomatology suggest that the majority of these patients report depressive symptoms before the onset of manic symptoms. However, prospective studies are scarce and this study will, therefore, prospectively examine the onset of either manic symptoms or a (hypo)manic episode in patients with a major depressive disorder. In addition, we will consider the impact of a large set of potential risk factors on both outcomes.

    METHODOLOGY: Four-year follow-up data were used to determine the onset of manic symptoms as well as a CIDI-based (hypo)manic episode in a large sample (n = 889, age: 18-65 years) of outpatients with a major depressive disorder and without manic symptoms at baseline. Baseline vulnerability (i.e., sociodemographics, family history of depression, childhood trauma, life-events) and clinical (i.e., isolated manic symptoms, depression characteristics, and psychiatric comorbidity) factors were considered as potential risk factors.

    RESULTS: In our sample of depressed patients, 15.9% developed manic symptoms and an additional 4.7% developed a (hypo)manic episode during four years. Baseline isolated manic symptoms and comorbid alcohol dependence predicted both the onset of manic symptoms and a (hypo)manic episode. Low education only predicted the onset of manic symptoms, whereas male gender, childhood trauma and severity of depressive symptoms showed strong associations with, especially, the onset of (hypo)manic episodes.

    CONCLUSIONS: A substantial proportion (20.6%) of patients with a major depressive disorder later developed manic symptoms or a (hypo)manic episode. Interestingly, some identified risk factors differed for the two outcomes, which may indicate that pathways leading to the onset of manic symptoms or a (hypo)manic episode might be different. Our findings indirectly support a clinical staging model.

    Original languageEnglish
    Article numbere106871
    Pages (from-to)1-8
    Number of pages8
    JournalPLoS ONE
    Volume9
    Issue number9
    DOIs
    Publication statusPublished - 26 Sep 2014

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    Major Depressive Disorder
    signs and symptoms (animals and humans)
    Depression
    Education
    Alcohols
    Wounds and Injuries
    Alcoholism
    Psychiatry
    Comorbidity
    risk factors
    Outpatients
    Retrospective Studies
    Prospective Studies
    childhood
    life events
    alcohol abuse
    prospective studies
    retrospective studies
    education

    Keywords

    • Adolescent
    • Adult
    • Aged
    • Bipolar Disorder/complications
    • Depressive Disorder, Major/complications
    • Female
    • Follow-Up Studies
    • Humans
    • Male
    • Middle Aged
    • Patient Outcome Assessment
    • Prognosis
    • Prospective Studies
    • Risk Factors
    • Young Adult

    Cite this

    Boschloo, L., Spijker, A. T., Hoencamp, E., Kupka, R. W., Nolen, W. A., Schoevers, R. A., & Penninx, B. W. J. H. (2014). Predictors of the onset of manic symptoms and a (hypo)manic episode in patients with major depressive disorder. PLoS ONE, 9(9), 1-8. [e106871]. https://doi.org/10.1371/journal.pone.0106871
    Boschloo, L. ; Spijker, A.T. ; Hoencamp, E. ; Kupka, R.W. ; Nolen, W.A. ; Schoevers, R.A. ; Penninx, B.W.J.H. / Predictors of the onset of manic symptoms and a (hypo)manic episode in patients with major depressive disorder. In: PLoS ONE. 2014 ; Vol. 9, No. 9. pp. 1-8.
    @article{a9f57b9865a743908d09336f1ceb6892,
    title = "Predictors of the onset of manic symptoms and a (hypo)manic episode in patients with major depressive disorder",
    abstract = "OBJECTIVE: One third of patients with a major depressive episode also experience manic symptoms or, even, a (hypo)manic episode. Retrospective studies on the temporal sequencing of symptomatology suggest that the majority of these patients report depressive symptoms before the onset of manic symptoms. However, prospective studies are scarce and this study will, therefore, prospectively examine the onset of either manic symptoms or a (hypo)manic episode in patients with a major depressive disorder. In addition, we will consider the impact of a large set of potential risk factors on both outcomes.METHODOLOGY: Four-year follow-up data were used to determine the onset of manic symptoms as well as a CIDI-based (hypo)manic episode in a large sample (n = 889, age: 18-65 years) of outpatients with a major depressive disorder and without manic symptoms at baseline. Baseline vulnerability (i.e., sociodemographics, family history of depression, childhood trauma, life-events) and clinical (i.e., isolated manic symptoms, depression characteristics, and psychiatric comorbidity) factors were considered as potential risk factors.RESULTS: In our sample of depressed patients, 15.9{\%} developed manic symptoms and an additional 4.7{\%} developed a (hypo)manic episode during four years. Baseline isolated manic symptoms and comorbid alcohol dependence predicted both the onset of manic symptoms and a (hypo)manic episode. Low education only predicted the onset of manic symptoms, whereas male gender, childhood trauma and severity of depressive symptoms showed strong associations with, especially, the onset of (hypo)manic episodes.CONCLUSIONS: A substantial proportion (20.6{\%}) of patients with a major depressive disorder later developed manic symptoms or a (hypo)manic episode. Interestingly, some identified risk factors differed for the two outcomes, which may indicate that pathways leading to the onset of manic symptoms or a (hypo)manic episode might be different. Our findings indirectly support a clinical staging model.",
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    author = "L. Boschloo and A.T. Spijker and E. Hoencamp and R.W. Kupka and W.A. Nolen and R.A. Schoevers and B.W.J.H. Penninx",
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    Boschloo, L, Spijker, AT, Hoencamp, E, Kupka, RW, Nolen, WA, Schoevers, RA & Penninx, BWJH 2014, 'Predictors of the onset of manic symptoms and a (hypo)manic episode in patients with major depressive disorder' PLoS ONE, vol. 9, no. 9, e106871, pp. 1-8. https://doi.org/10.1371/journal.pone.0106871

    Predictors of the onset of manic symptoms and a (hypo)manic episode in patients with major depressive disorder. / Boschloo, L.; Spijker, A.T.; Hoencamp, E.; Kupka, R.W.; Nolen, W.A.; Schoevers, R.A.; Penninx, B.W.J.H.

    In: PLoS ONE, Vol. 9, No. 9, e106871, 26.09.2014, p. 1-8.

    Research output: Contribution to JournalArticleAcademicpeer-review

    TY - JOUR

    T1 - Predictors of the onset of manic symptoms and a (hypo)manic episode in patients with major depressive disorder

    AU - Boschloo, L.

    AU - Spijker, A.T.

    AU - Hoencamp, E.

    AU - Kupka, R.W.

    AU - Nolen, W.A.

    AU - Schoevers, R.A.

    AU - Penninx, B.W.J.H.

    PY - 2014/9/26

    Y1 - 2014/9/26

    N2 - OBJECTIVE: One third of patients with a major depressive episode also experience manic symptoms or, even, a (hypo)manic episode. Retrospective studies on the temporal sequencing of symptomatology suggest that the majority of these patients report depressive symptoms before the onset of manic symptoms. However, prospective studies are scarce and this study will, therefore, prospectively examine the onset of either manic symptoms or a (hypo)manic episode in patients with a major depressive disorder. In addition, we will consider the impact of a large set of potential risk factors on both outcomes.METHODOLOGY: Four-year follow-up data were used to determine the onset of manic symptoms as well as a CIDI-based (hypo)manic episode in a large sample (n = 889, age: 18-65 years) of outpatients with a major depressive disorder and without manic symptoms at baseline. Baseline vulnerability (i.e., sociodemographics, family history of depression, childhood trauma, life-events) and clinical (i.e., isolated manic symptoms, depression characteristics, and psychiatric comorbidity) factors were considered as potential risk factors.RESULTS: In our sample of depressed patients, 15.9% developed manic symptoms and an additional 4.7% developed a (hypo)manic episode during four years. Baseline isolated manic symptoms and comorbid alcohol dependence predicted both the onset of manic symptoms and a (hypo)manic episode. Low education only predicted the onset of manic symptoms, whereas male gender, childhood trauma and severity of depressive symptoms showed strong associations with, especially, the onset of (hypo)manic episodes.CONCLUSIONS: A substantial proportion (20.6%) of patients with a major depressive disorder later developed manic symptoms or a (hypo)manic episode. Interestingly, some identified risk factors differed for the two outcomes, which may indicate that pathways leading to the onset of manic symptoms or a (hypo)manic episode might be different. Our findings indirectly support a clinical staging model.

    AB - OBJECTIVE: One third of patients with a major depressive episode also experience manic symptoms or, even, a (hypo)manic episode. Retrospective studies on the temporal sequencing of symptomatology suggest that the majority of these patients report depressive symptoms before the onset of manic symptoms. However, prospective studies are scarce and this study will, therefore, prospectively examine the onset of either manic symptoms or a (hypo)manic episode in patients with a major depressive disorder. In addition, we will consider the impact of a large set of potential risk factors on both outcomes.METHODOLOGY: Four-year follow-up data were used to determine the onset of manic symptoms as well as a CIDI-based (hypo)manic episode in a large sample (n = 889, age: 18-65 years) of outpatients with a major depressive disorder and without manic symptoms at baseline. Baseline vulnerability (i.e., sociodemographics, family history of depression, childhood trauma, life-events) and clinical (i.e., isolated manic symptoms, depression characteristics, and psychiatric comorbidity) factors were considered as potential risk factors.RESULTS: In our sample of depressed patients, 15.9% developed manic symptoms and an additional 4.7% developed a (hypo)manic episode during four years. Baseline isolated manic symptoms and comorbid alcohol dependence predicted both the onset of manic symptoms and a (hypo)manic episode. Low education only predicted the onset of manic symptoms, whereas male gender, childhood trauma and severity of depressive symptoms showed strong associations with, especially, the onset of (hypo)manic episodes.CONCLUSIONS: A substantial proportion (20.6%) of patients with a major depressive disorder later developed manic symptoms or a (hypo)manic episode. Interestingly, some identified risk factors differed for the two outcomes, which may indicate that pathways leading to the onset of manic symptoms or a (hypo)manic episode might be different. Our findings indirectly support a clinical staging model.

    KW - Adolescent

    KW - Adult

    KW - Aged

    KW - Bipolar Disorder/complications

    KW - Depressive Disorder, Major/complications

    KW - Female

    KW - Follow-Up Studies

    KW - Humans

    KW - Male

    KW - Middle Aged

    KW - Patient Outcome Assessment

    KW - Prognosis

    KW - Prospective Studies

    KW - Risk Factors

    KW - Young Adult

    U2 - 10.1371/journal.pone.0106871

    DO - 10.1371/journal.pone.0106871

    M3 - Article

    VL - 9

    SP - 1

    EP - 8

    JO - PLoS ONE

    JF - PLoS ONE

    SN - 1932-6203

    IS - 9

    M1 - e106871

    ER -