Association Between Bipolar Spectrum Features and Treatment Outcomes in Outpatients With Major Depressive Disorder

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Abstract
The distinction between major depressive disorder (MDD) and bipolar disorder remains a challenging clinical problem when individuals present with a major depressive episode.1-3 A number of illness features have been proposed to indicate risk of bipolar disorder in this setting, including earlier age of illness onset,4-7 greater number of depressive recurrences or briefer episodes,4,6,8,9 family history of bipolar disorder,6,9-11 and aspects of temperament such as hyperthymia and cyclothymia.12-15 Symptomatic differences have also been proposed, among them presence of irritability or anger,16-19 presence of psychotic symptoms,10,11,20-26 suicidality,6,25 and atypical neurovegetative symptoms7,23,27-29 including psychomotor agitation or slowing.10,30,31 Moreover, even in individuals who do not meet full syndromal criteria for bipolar I or II disorder, it has been suggested that these illness features may be markers for an underlying bipolar diathesis or bipolar spectrum illness.2,32

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