Agitated "Unipolar" Major Depression: Prevalence, Phenomenology, and Outcome
J Clin Psychiatry 2006;67(5):712-719
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: This study aimed to explore
how prevalent agitated "unipolar" major depression
is, whether it belongs to the bipolar spectrum,
and whether it differs from nonagitated
"unipolar" major depression with respect to course and
Method: The study was conducted from January 1, 1978, to December 31, 1996. From 361 patients with major depressive disorder,
the authors selected those fulfilling Research
Diagnostic Criteria for agitated depression. These
94 patients were compared to 94 randomly recruited patients with nonagitated major depressive
disorder regarding demographic and historical features, the clinical characteristics of the index
episode, the percentage of time spent in an
affective episode during a prospective observation
period, and the 5-year outcome. Patients with
agitated major depressive disorder who had at least
2 manic/hypomanic symptoms in their index episode were compared to the other patients
with agitated major depressive disorder with respect
to the same variables.
Results: Patients with agitated major
depressive disorder were more likely to receive
antipsychotics during their index episode and spent
a higher proportion of time in an affective
episode during the observation period compared with
patients with nonagitated major depressive
disorder. The presence of at least 2
manic/hypomanic symptoms in the index episode was
associated with a higher rate of family history of bipolar
I disorder, a higher score for suicidal thoughts
during the episode, a longer duration of the
episode, and a higher affective morbidity during the
Conclusion: The diagnosis of agitated
major depressive disorder is not uncommon and has significant therapeutic and prognostic
implications. The subgroup of patients with at least
2 manic/hypomanic symptoms may suffer from a mixed state and/or belong to the bipolar