Clinical Guidance: Subthreshold Hypomanic Symptoms and Subsequent Bipolar Disorder
A 20-year prospective study of the course of depressive disorder showed that nearly 25% of patients initially diagnosed as having unipolar major depressive disorder eventually developed either bipolar I or bipolar II mood disorder. Conversion to bipolar disorder was more frequent in patients with earlier onset and more severe symptoms, psychosis, and hypomanic symptoms. Less need for sleep, unusual energy, and increased goal-directed activities were the symptoms most frequently associated with later mania, according to Fiedorowicz et al. (p. 40). However, the majority of patients who later converted had no predictive signs. In his editorial (p. 4), Schneck suggests that in the absence of clinical or biomarker indicators for incipient bipolar disorder in most patients, it might be prudent to initiate psychoeducational approaches, such as family stress reduction and social rhythm therapies, with all young depressed patients and their families, to help mitigate the effects of a later conversion to bipolar disorder.