Agitated depression in bipolar II disorder.

STUDY AIM: To test diagnostic validity or utility of agitated depression (AD) in bipolar II disorder (BP-II).

METHODS

Three hundred and twenty BP-II major depressive episode (MDE) outpatients interviewed with the Structured Clinical Interview for DSM-IV, Hypomania Interview Guide (HIG), and Family History Screen. AD defined as MDE with psychomotor agitation. Mixed depression defined as MDE with > or =4 hypomanic symptoms. AD, non-AD, mixed-AD, non-mixed-AD, and mixed-non-AD were compared versus diagnostic validators.

RESULTS

AD was present in 35.0%, 75.8% of AD were mixed, while only 14.3% of non-AD were mixed (P=0.0000). AD (n=112), versus non-AD (n=208), had significantly higher age, more females, recurrences, bipolar I family history, and much more concurrent hypomanic symptoms. Mixed-AD (n=85), versus non-mixed-AD (n=27), was not significantly different, apart from more hypomanic symptoms (by definition), but there were clinically significant differences.

CONCLUSIONS

Findings may partly support subtyping of AD in BP-II, on the basis of its frequent clustering of hypomanic symptoms, and its different family history. This subtyping may impact on treatment of BP-II depression, as antidepressants alone may increase agitation while mood stabilising agents can treat agitation before using antidepressants.