Subsyndromal Depressive Symptoms After Symptomatic Recovery From Mania Are Associated With Delayed Functional Recovery

Objective: This study examined whether the presence of subsyndromal depressive symptoms predicted functional recovery after an acute manic episode.

Method: Subjects with bipolar I disorder (according to the Structured Clinical Interview for DSM-IV) who, at the time of symptomatic recovery from an acute manic or hypomanic episode, had a concomitant functional recovery (n = 52) were compared on demographic variables and mood symptoms to those who had symptomatically recovered but not functionally recovered (n = 33). Demographic and mood variables were examined in the nonfunctionally recovered group to assess predictors of time to functional recovery. The primary functional outcome measure used was the Life Functioning Questionnaire, a 5-minute, gender-neutral self-report scale to measure role function in 4 domains: workplace, duties at home, leisure time with family, and leisure time with friends. Participants in the study were recruited from July 2000 through February 2005.

Results: Depressive symptoms, even at a subsyndromal level, were significantly associated with persisting functional impairment after symptomatic recovery from a manic episode (P < .02). Subsyndromal depressive symptoms also significantly predicted a slower time to functional recovery over the next 9 months (P = .006).

Conclusion: The presence of even mild subsyndromal depressive symptoms may interfere with functional recovery in patients with bipolar disorder after symptomatic recovery from a manic or hypomanic episode.

J Clin Psychiatry

Submitted: April 16, 2009; accepted October 27, 2009.

Online ahead of print: June 29, 2010 (doi:10.4088/JCP.09m05291gre).

Corresponding author: Michael J. Gitlin, MD, 300 UCLA Medical Plaza, Ste 2200, Los Angeles, CA 90095 (mgitlin@mednet.ucla.edu).