Advanced Search

The American Journal of Psychiatry, VOL. 158, No. 8

Letter to the Editor | August 01, 2001

Classifying Depression

FRANCO BENAZZI, M.D.

Am J Psychiatry 2001;158:1333-1334. 10.1176/appi.ajp.158.8.1333

Article

References

text A A A

To the Editor: Dr. Parker reported that bipolar depression is melancholic. Bipolar I and II may be distinct disorders (1, 2). The prevalence of melancholic features may be low in bipolar II outpatients with depression (3), a common (30%–50% of depressed outpatients) and often atypical depression (4, 5). Bipolar II depression in outpatients may be different from the bipolar I depression, primarily in inpatients, studied by Dr. Parker.

Sixty-four consecutive outpatients with unipolar disorders (major depressive disorder or dysthymic disorder) and 97 consecutive outpatients with bipolar II disorder who were seen for treatment of a major depressive episode in a private practice were interviewed at intake with the Structured Clinical Interview for DSM-IV Axis I Disorders—Clinician Version (6). Because the modal duration of hypomania is 1–3 days (7), the 4-day minimum duration of hypomania found in DSM-IV was not a criterion. "At least some days" of hypomania were required in the bipolar outpatients (5). Most bipolar II subjects had experienced 2–3 days of hypomania, and all had had more than one episode of hypomania. Family members or close friends supplemented clinical information. After complete description of study to the subjects, written informed consent was obtained.

Melancholic features were present in 20 of the bipolar II subjects (20.6%) and in 16 of the unipolar subjects (25.0%) (χ²=0.42, df=1, p=0.51, two-tailed). Atypical features were present in 44 of the bipolar II subjects (45.4%) and in 11 of the unipolar subjects (17.2%) (χ²=13.60, df=1, p=0.0002, two-tailed). These findings are in line with those from previous reports (4, 7–10). Outpatient bipolar II depression seems more atypical, not more melancholic, than unipolar depression. Bipolar I and II depressions may have different clinical pictures in different settings.

References

Benazzi F: A comparison of the age of onset of bipolar I and bipolar II outpatients. J Affect Disord 1999; 54:249-253[PubMed][CrossRef]

Coryell W: Bipolar II disorder: the importance of hypomania, in Bipolar Disorders: Clinical Course and Outcome. Edited by Goldberg JF, Harrow M. Washington, DC, American Psychiatric Press, 1999, pp 219-236

Benazzi F: Bipolar II depression with melancholic features. Ann Clin Psychiatry 2000; 12:29-33[PubMed]

Benazzi F: Prevalence and clinical features of atypical depression in depressed outpatients: a 467-case study. Psychiatry Res 1999; 86:259-265[PubMed][CrossRef]

Akiskal HS: Mood disorders: clinical features, in Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, 7th ed. Edited by Sadock BJ, Sadock VA. Philadelphia, Lippincott Williams & Wilkins, 2000, pp 1338-1377

First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders—Clinician Version (SCID-CV). Washington, DC, American Psychiatric Press, 1997

Akiskal HS: The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J Clin Psychopharmacol 1996; 16(suppl 1):4S-14S

Himmelhoch JM: The paradox of anxiety syndromes comorbid with the bipolar illnesses, in Bipolar Disorders: Clinical Course and Outcome. Edited by Goldberg JF, Harrow M. Washington, DC, American Psychiatric Press, 1999, pp 237-258

Perugi G, Akiskal HS, Lattanzi L, Cecconi D, Mastrocinque C, Patronelli A, Vignoli S, Bemi E: The high prevalence of "soft" bipolar (II) features in atypical depression. Compr Psychiatry 1998; 39:63-71[PubMed][CrossRef]

Baldessarini R: A plea for integrity of the bipolar disorder concept. Bipolar Disord 2000; 2:3-7[PubMed][CrossRef]

Benazzi F: A comparison of the age of onset of bipolar I and bipolar II outpatients. J Affect Disord 1999; 54:249-253[PubMed][CrossRef]

Benazzi F: Bipolar II depression with melancholic features. Ann Clin Psychiatry 2000; 12:29-33[PubMed]

Benazzi F: Prevalence and clinical features of atypical depression in depressed outpatients: a 467-case study. Psychiatry Res 1999; 86:259-265[PubMed][CrossRef]

First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders—Clinician Version (SCID-CV). Washington, DC, American Psychiatric Press, 1997

Akiskal HS: The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J Clin Psychopharmacol 1996; 16(suppl 1):4S-14S

Baldessarini R: A plea for integrity of the bipolar disorder concept. Bipolar Disord 2000; 2:3-7[PubMed][CrossRef]

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.

Submit a Comments

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of JBJS editorial staff.

* = Required Field

Comment Author(s)*(if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Comment Title*

Comment*

Cancel

Print
E-mail

Recipient(s) will receive an email with a link (good for 72 hours) to 'Classifying Depression' and do not need to have American Journal of Psychiatry account to access the content.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*
Separate multiple email address with semi-colons (up to 5).

Subject:* 's American Journal of Psychiatry: 'Classifying Depression'
Subject for your email.

Message:
(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The American Psychiatric Association (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that you are requesting the material solely for personal, non-commercial use, and that it is subject to The American Psychiatric Association's Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The American Psychiatric Association's Privacy Policy for further information.

Copyright © American Psychiatric Association. All rights reserved.
Share
Get Citation

FRANCO BENAZZI; Classifying Depression. American Journal of Psychiatry. 2001 Aug;158(8):1333-1334.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © American Psychiatric Association. All rights reserved.
Reprints