Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Catalonia, Spain.
J Clin Psychiatry. 2019 Feb 19;80(2):17m12082. doi: 10.4088/JCP.17m12082.
This post hoc analysis of the BRIDGE-II-MIX study is aimed at evaluating affective lability (AL) as a possible clinical feature of mixed depression and assessing the relationship with atypical depressive features, particularly mood reactivity (MR).
In the BRIDGE-II-MIX multicenter, cross-sectional study, 2,811 individuals suffering from a major depressive episode (MDE; DSM-IV-TR criteria), in the context of bipolar I or II disorder (BD-I, BD-II, respectively) or major depressive disorder, were enrolled between June 2009 and July 2010. Patients with (MDE-AL, n = 694) and without (MDE-noAL, n = 1,883) AL and with (MDE-MR, n = 1,035) or without (MDE-noMR, n = 1,542) MR were compared through χ² test or Student t test. Stepwise backward logistic regression models, respectively testing AL and MR as the dependent variable, were performed to differentiate the 2 clinical constructs.
AL was positively associated with BD-I (P < .001) and BD-II (P < .001), with DSM-5 mixed (DSM-5-MXS) (P < .001) and atypical (DSM-5-AD) features (P < .001) and negatively associated with MDD (P < .001). In the logistic regression models, MR was the variable most significantly associated with AL and vice versa (P < .001 for both). AL was positively associated with severity of mania and DSM-5-MXS and negatively correlated with severity of depression, while MR was better predicted by atypical symptoms such as hyperphagia, hypersomnia, and leaden paralysis and correlated with both comorbid anxiety disorders and DSM-5-MXS.
Mixed and atypical depression may lie on the same continuum. MR and AL could represent the underlying matrix, bridging the gap between mixed and atypical depression.
这项 BRIDGE-II-MIX 研究的事后分析旨在评估情感不稳定性（AL）作为混合性抑郁的一种可能的临床特征，并评估其与非典型抑郁特征的关系，特别是情绪反应性（MR）。
在 BRIDGE-II-MIX 多中心、横断面研究中，2009 年 6 月至 2010 年 7 月期间，共招募了 2811 名患有重性抑郁发作（MDE；DSM-IV-TR 标准）的个体，分别患有双相 I 型或 II 型障碍（BD-I、BD-II）或重性抑郁障碍。通过 χ²检验或学生 t 检验比较有（MDE-AL，n=694）和无（MDE-noAL，n=1883）AL 以及有（MDE-MR，n=1035）和无（MDE-noMR，n=1542）MR 的患者。分别进行逐步向后逻辑回归模型，以测试 AL 和 MR 作为因变量，以区分这两种临床结构。
AL 与 BD-I（P<0.001）和 BD-II（P<0.001）、DSM-5 混合（DSM-5-MXS）（P<0.001）和非典型（DSM-5-AD）特征（P<0.001）呈正相关，与 MDD（P<0.001）呈负相关。在逻辑回归模型中，MR 是与 AL 最显著相关的变量，反之亦然（P<0.001）。AL 与躁狂严重程度和 DSM-5-MXS 呈正相关，与抑郁严重程度呈负相关，而 MR 则更好地由暴饮暴食、嗜睡和铅样麻痹等非典型症状预测，并与并存的焦虑障碍和 DSM-5-MXS 相关。
混合性和非典型性抑郁可能处于同一连续体上。MR 和 AL 可能代表着混合性和非典型性抑郁之间的潜在基质。
