Many Depressed People Have Mild, Brief Episodes of
TUESDAY, Aug. 17 (HealthDay News) -- Nearly 40 percent of
Americans with major depression also have brief but recurring
episodes of manic behavior, a new study suggests.
Researchers at the U.S. National Institute of Mental Health
(NIMH) reported that these patients have what's called
"subthreshold hypomania" -- meaning a milder form of mania that
lasts fewer than four days, and is therefore below the threshold
for bipolar disorder.
"With hypomania, people may be more active and energetic than usual, and they may sleep less and become agitated more easily," said the study's senior author, Kathleen Merikangas, a senior investigator at the NIMH in Bethesda, Md. "The behavior is definitely different than their usual state, but it doesn't cause impairment in their lives."
The findings were published Aug. 16 in the online advance
edition of the
American Journal of Psychiatry.
Merikangas and her colleagues analyzed data from a survey of
more than 5,000 U.S. households. They found that people with
subthreshold hypomania have higher rates of anxiety and substance
abuse and more depressive episodes than depressed people who don't
exhibit manic behavior. What's more, they were just as likely to
have a family history of mania as people with bipolar disorder,
which suggests that they may be at a higher risk of developing
full-blown bipolar disorder down the road.
Although these mild episodes of mania last only two or three
days, they recur frequently, Merikangas said. She stressed that
some periods of high energy are entirely natural. "If someone has
one instance where she feels really good for a few days because of
something that happened in her life, like falling in love, that's
not subthreshold hypomania," Merikangas said.
A true manic episode lasts for one week or more, often includes
psychotic symptoms and sometimes requires hospitalization. However,
the researchers noted that most people with bipolar disorder
experience hypomania rather than mania.
"This study really helps consolidate an idea that's been around for a while, which is that there's a broad continuum -- ranging from pure unipolar depression to classic bipolar depression," said Dr. Gregory Simon, a psychiatrist and mental health researcher at the Group Health Research Institute in Seattle.
Simon added that the findings raise questions about treatment
implications, which need to be addressed in future studies. "Does
it mean that these people may get greater benefit from some
treatments rather than others? There's a way to answer that
question, but we haven't done that yet."
In the meantime, Merikangas advises friends and family members
to be aware of a loved one who behaves in a way that's
uncharacteristic for them for a few days, like drinking more than
usual or spending a lot of money, and then goes back to normal.
"If you see this kind of behavior, it's really wise for that person to get an evaluation by a mental health professional," she said. "The idea is to intervene before someone develops more serious problems, like drug and alcohol abuse. We can't prevent bipolar disease from occurring, but we can prevent the consequences."
There's more on bipolar disorder at the
U.S. National Library of Medicine.
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