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Comparative Study
. 2018 Mar 16;18(1):68.
doi: 10.1186/s12888-018-1641-y.

Psychopathological and sociodemographic features in treatment-resistant unipolar depression versus bipolar depression: a comparative study

Nicolas A Nuñez  1   2 , Stefano Comai  1   3 , Eduard Dumitrescu  1   2 , Maykel F Ghabrash  1   2 , John Tabaka  1   2 , Marie Saint-Laurent  2 , Stephen Vida  2 , Theodore Kolivakis  2 , Allan Fielding  2 , Nancy Low  2 , Pablo Cervantes  2 , Linda Booij  1   4 , Gabriella Gobbi  5   6
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Comparative Study

Psychopathological and sociodemographic features in treatment-resistant unipolar depression versus bipolar depression: a comparative study

Nicolas A Nuñez et al. BMC Psychiatry. .

Abstract

Background: Some authors have hypothesized that Treatment-Resistant Unipolar Depression (TRD-UP) should be considered within the bipolar spectrum disorders and that hidden bipolarity may be a risk factor for TRD-UP. However, there are neither studies comparing clinical and sociodemographic data of patients with TRD-UP versus Bipolar (BP) disorders nor are there any examining differences versus Bipolar type I (BP-I) and Bipolar type II (BP-II).

Methods: Charts analysis was conducted on 194 patients followed at the Mood Disorders Clinic of the McGill University Health Center. Sociodemographic, clinical features and depression scales were collected from patients meeting DSM-IV criteria for TRD-UP (n = 100) and BP (n = 94). Binary logistic regression analysis was conducted to examine clinical predictors independently associated with the two disorders.

Results: Compared to BP, TRD-UP patients exhibited greater severity of depression, prevalence of anxiety and panic disorders, melancholic features, Cluster-C personality disorders, later onset of depression and fewer hospitalizations. Binary logistic regression indicated that higher comorbidity with anxiety disorders, higher depression scale scores and lower global assessment of functioning (GAF) scores, and lower number of hospitalizations and psychotherapies differentiated TRD-UP from BP patients. We also found that the rate of unemployment and the number of hospitalizations for depression was higher in BP-I than in BP-II, while the rate of suicide attempts was lower in BP-I than in BP-II depressed patients.

Conclusions: These results suggest that TRD-UP constitutes a distinct psychopathological condition and not necessarily a prodromal state of BP depression.

Keywords: Affective disorders; Bipolar depression; Bipolar spectrum; Psychopathology; Treatment-resistant depression.

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Conflict of interest statement

Ethics approval and consent to participate

The chart review study was approved by the Institutional Review Board of McGill University (13–375-PSY) and was conducted in accordance with the Declaration of Helsinki and ICH Good Clinical Practice. Registered November 2013.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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