Manic symptoms in patients with depressive and/or anxiety disorders

Background: Previous studies found that patients with depressive disorders frequently have lifetime manic symptoms or even an unrecognized bipolar disorder and that these patients have more severe illness. In this study we investigated whether the presence of significant manic symptoms among patients presenting with depressive and/or anxiety disorders is associated with more severe illness, more comorbidity, more suicidality and more atypical symptoms. Methods: In a large cohort (n=2012) of persons with lifetime depressive and/or anxiety disorders (as confirmed with the Composite International Diagnostic interview (CIDI)) we used the 15-item Mood Disorder Questionnaire (MDQ) to assess the presence of lifetime manic symptoms. Patients with clinically recognized bipolar disorders were excluded from the study. Results: Lifetime manic symptoms were present among 6.3% of the persons with depressive or anxiety disorders. Persons with lifetime manic symptoms more frequently had comorbid social phobia, generalized anxiety disorder and alcohol dependence, more frequently reported previous serious suicide attempts and their current depressive symptoms were more severe. Atypical depression symptoms were not more prevalent in persons with lifetime manic symptoms. Limitations: The presence of a lifetime manic or hypomanic episode was not assessed with the CIDI. Conclusions: Identifying lifetime manic symptoms with the MDQ in persons presenting with (unipolar) depressive or anxiety disorders, can not only help the recognition of actual bipolar disorder (as described in previous studies), but also the identification of a subgroup of patients with more severe symptomatology, more comorbid anxiety and alcohol dependence disorders, and more suicidality. Crown Copyright (C) 2010 Published by Elsevier B.V. All rights reserved.