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Vol. 76, No. 6, 2007
Issue release date: October 2007
Psychother Psychosom 2007;76:325–331

Evidence for Two Types of Bipolar Depression Using a Dimensional Approach

Henry C. · M’Baïlara K. · Poinsot R. · Casteret A.-A. · Sorbara F. · Leboyer M. · Vieta E.
aHôpital Charles Perrens, Bâtiment Lescure, and bLaboratoire de Psychologie Clinique et Psychopathologie JE 2358, Université Victor Segalen, Bordeaux, cInstitut Curie, Unité de Psycho-Oncologie, Paris, dClinique des Orchidées, Andilly, eDépartement de Psychiatrie, Hôpital Chenevier-Mondor, Université Paris XII, Paris, and fINSERM U-841, Créteil, France; gBipolar Disorders Program, IDIBAPS, Clinical Institute of Neuroscience, University of Barcelona Hospital, Barcelona, and hRed de Enfermedades Mentales (REM-TAP Network), Instituto de Salud Carlos III, Madrid, Spain

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Background: Although there is a great heterogeneity of depressive states in bipolar patients, there is only one definition in international classifications for describing them. However, this variety seems particularly important to recognize because of the possible exacerbation of some of these bipolar depressive states by antidepressants. We aimed at assessing whether it is possible to distinguish different forms of bipolar depression using a dimensional approach. Methods: We characterized 60 bipolar patients with a Major Depressive Episode (DSM-IV) using a new tool (MAThyS; Multidimensional Assessment of Thymic States), assessing five fundamental dimensions (emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception) of mood states. Results: A cluster analysis using the items of the dimensional scale revealed two types of depressive state: group 1 (n = 38), which had a low score, is characterized by an inhibition in all dimensions, whereas group 2 (n = 22) is characterized by an overactivation. The emotional reactivity is the most relevant dimension for discriminating these two types of depression (group 1: hyporeactivity; group 2: hyperreactivity), whereas sadness is not. Conclusions: Bipolar depressive states are not homogeneous. A dimensional approach based on emotional reactivity could be useful for discriminating the different forms of bipolar depression. Bipolar depressions may be classified as hyporeactive or hyperreactive. This classification might have therapeutic implications, because hyperreactive depression should belong to the broad spectrum of mixed states.

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  1. Kraepelin E: Manic-Depressive Insanity and Paranoia. Edinburgh, Livingstone, 1921.
  2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, American Psychiatric Association, 1994.
  3. Goodwin FK, Jamison KR: Manic-Depressive Illness. New York, Oxford University Press, 1990.
  4. Koukopoulos A, Koukopoulos AE: Agitated depression as a mixed state and the problem of melancholia. Psychiatr Clin North Am 1999;22:547–564.
  5. Akiskal HS: Bipolar depression: focus on phenomenology. J Affect Disord 2005;84:105–106.
  6. Benazzi F: Mixed states in bipolar II disorder: should full hypomania always be required? Psychiatry Res 2004;127:247–257.
  7. Benazzi F, Akiskal HS: Psychometric delineation of the most discriminant symptoms of depressive mixed states. Psychiatry Res 2006;141:81–88.
  8. Sato T, Bottlender R, Kleindienst N, Möller HJ: Irritable psychomotor elation in depressed inpatients: a factor validation of mixed depression. J Affect Disord 2005;84:187–196.
  9. Biondi M, Picardi A, Pasquini M, Gaetano P, Pancheri P: Dimensional psychopathology of depression: detection of an ‘activation’ dimension in unipolar depressed outpatients. J Affect Disord 2005;84:133–139.
  10. Benazzi F, Akiskal H: Irritable-hostile depression: further validation as a bipolar depressive mixed state. J Affect Disord 2005;84:197–207.
  11. Akiskal HS: The dark side of bipolarity: detecting bipolar depression in its pleomorphic expressions. J Affect Disord 2005;84:107–115.
  12. Bauer MS, Whybrow PC, Gyulai L, Gonnel J, Yeh HS: Testing definitions of dysphoric mania and hypomania: prevalence, clinical characteristics and inter-episode stability. J Affect Disord 1994;32:201–211.
  13. McElroy SL, Keck PE Jr, Pope HG Jr, Hudson JF, Faedda GL, Swann AC: Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania. Am J Psychiatry 1992;149:1633–1644.
  14. McElroy SL, Strakowski SM, Keck PE Jr, Tugrul KL, West SA, Lonczak HS: Differences and similarities in mixed and pure mania. Compr Psychiatry 1995;36:187–194.
  15. Henry C, M’Bailara K, Poinsot R, Falissard B: Construction et validation d’une échelle dimensionnelle de l’humeur: la MAThyS (Multidimensional Assessment of Thymic States). Encéphale, in press.
  16. Henry C, Swendsen J, Van den Bulke D, Sorbara F, Leboyer M: Emotional hyperreactivity as the fundamental mood characteristic of manic and mixed states. Eur Psychiatry 2003;18:124–128.
  17. Nurnberger JI Jr, Blehar MC, Kaufmann CA, Yok-Cooler C, Simpson SG, Harkavy-Friedman J, Severe JB, Malaspina D, Reich T: Diagnostic interview for genetics studies: rationale, unique features, and training. NIMH Genetics Initiative. Arch Gen Psychiatry 1994;51:849–859; discussion 863–864.
  18. Montgomery S, Åsberg A: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.
  19. Bech P, Rafaelsen OJ, Kramp P, Bolwig TG: The Mania Rating Scale: scale construction and inter-observer agreement. Neuropharmacology 1978;17:430–431.
  20. Benazzi F: Depression with racing thoughts. Psychiatry Res 2003;120:273–282.
  21. Benazzi F, Koukopoulos A, Akiskal HS: Toward a validation of a new definition of agitated depression as a bipolar mixed state (mixed depression). Eur Psychiatry 2004;19:85–90.
  22. Akiskal HS, Benazzi F, Perugi G, Rihmer Z: Agitated ‘unipolar’ depression re-conceptualized as a depressive mixed state: implications for the antidepressant-suicide controversy. J Affect Disord 2005;85:245–258.
  23. Koukopoulos A, Alberti MJ, Sani G, Koukopoulos AE, Girardi P: Mixed depressive states: nosologic and therapeutic issues. Int Rev Psychiatry 2005;17:21–37.
  24. Dilsaver SC, Benazzi F, Akiskal HS: Mixed states: the most common outpatient presentation of bipolar depressed adolescents? Psychopathology 2005;38:268–272.
  25. Benazzi F: Suicidal ideation and depressive mixed states. Psychother Psychosom 2005;74:61–62.
  26. Hasler G, Drevets WC, Manji HK, Charney DS: Discovering endophenotypes for major depression. Neuropsychopharmacology 2004;29:1765–1781.
  27. Henry C, Van den Bulke D, Demazeau N, Demotes-Mainard J: Why are some depressions worsened by antidepressants? Bipolar Disord 2003;5:24.
  28. Fava M, Rush AJ: Current status of augmentation and combination treatments for major depressive disorder: a literature review and a proposal for a novel approach to improve practice. Psychother Psychosom 2006;75:139–153.
  29. Brugue E, Vieta E: Atypical antipsychotics in bipolar depression: neurobiological basis and clinical implications. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:275–282.
  30. Yatham LN, Goldstein JM, Vieta E, Bowden CL, Grunze H, Post RM, Suppes T, Calabrese JR: Atypical antipsychotics in bipolar depression: potential mechanisms of action. J Clin Psychiatry 2005;66(Suppl 5):40–48.

    External Resources

  31. Vieta E: Bipolar mixed states and their treatment. Expert Rev Neurother 2005;5:63–68.
  32. Vieta E: Case for caution, case for action. Bipolar Disord 2003;5:434–435.

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