This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (197)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Bipolar Disorder  • Depression  • Alert me on articles by topic

Lewis L. Judd, MD; Hagop S. Akiskal, MD; Pamela J. Schettler, PhD; William Coryell, MD; Jean Endicott, PhD; Jack D. Maser, PhD; David A. Solomon, MD; Andrew C. Leon, PhD; Martin B. Keller, MD

Arch Gen Psychiatry. 2003;60:261-269.

Background  This is the first prospective longitudinal study, to our knowledge, of the natural history of the weekly symptomatic status of bipolar II disorder (BP-II).

Methods  Weekly affective symptom status ratings for 86 patients with BP-II were based on interviews conducted at 6- or 12-month intervals during a mean of 13.4 years of prospective follow-up. Percentage of weeks at each symptom severity level and the number of shifts in symptom status and polarity were examined. Predictors of chronicity for BP-II were evaluated using new chronicity measures. Chronicity was also analyzed in relation to the percentage of follow-up weeks with different types of somatic treatment.

Results  Patients with BP-II were symptomatic 53.9% of all follow-up weeks: depressive symptoms (50.3% of weeks) dominated the course over hypomanic (1.3% of weeks) and cycling/mixed (2.3% of weeks) symptoms. Subsyndromal, minor depressive, and hypomanic symptoms combined were 3 times more common than major depressive symptoms. Longer intake episodes, a family history of affective disorders, and poor previous social functioning predicted greater chronicity. Prescribed somatic treatment did not correlate significantly with symptom chronicity. Patients with BP-II of brief (2-6 days) vs longer (7 days) hypomanias were not significantly different on any measure.

Conclusions  The longitudinal symptomatic course of BP-II is chronic and is dominated by depressive rather than hypomanic or cycling/mixed symptoms. Symptom severity fluctuates frequently within the same patient over time, involving primarily symptoms of minor and subsyndromal severity. Longitudinally, BP-II is expressed as a dimensional illness involving the full severity range of depressive and hypomanic symptoms. Hypomania of long or short duration in BP-II seems to be part of the same disease process.

From the Department of Psychiatry, University of California, San Diego (Drs Judd, Akiskal, and Schettler); the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression–Clinical Studies, Bethesda, Md (Drs Coryell, Endicott, Solomon, Leon, and Keller); and Psychiatry and Psychology Services, Department of Veterans Affairs, San Diego Health Care System (Drs Akiskal and Maser). Dr Keller is or has been a consultant for, received honoraria or grant support from, or serves on the advisory board of several pharmaceutical companies.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Residual Symptom Recovery From Major Affective Episodes in Bipolar Disorders and Rapid Episode Relapse/Recurrence
Judd et al.
Arch Gen Psychiatry 2008;65:386-394.
ABSTRACT | FULL TEXT  

The many ailments of Herman Melville (1819-91)
Ross
J Med Biogr 2008;16:21-29.
ABSTRACT | FULL TEXT  

Management of Bipolar Disorder in the Acute and Maintenance Settings
Baldassano
J Am Psychiatr Nurses Assoc 2007;13:S16-S22.
ABSTRACT  

Comparison of Older Patients With Bipolar Disorder and Schizophrenia/Schizoaffective Disorder
Gupta et al.
AJGP 2007;15:627-633.
ABSTRACT | FULL TEXT  

Stimulating Research: A Prospective, Randomized, Double-Blind, Sham-Controlled Study of Slow Transcranial Magnetic Stimulation in Depressed Bipolar Patients
Tamas et al.
J. Neuropsychiatry Clin. Neurosi. 2007;19:198-199.
FULL TEXT  

Psychosocial Treatments for Bipolar Depression: A 1-Year Randomized Trial From the Systematic Treatment Enhancement Program
Miklowitz et al.
Arch Gen Psychiatry 2007;64:419-426.
ABSTRACT | FULL TEXT  

The bipolar spectrum
Angst
Br. J. Psychiatry 2007;190:189-191.
ABSTRACT | FULL TEXT  

Patterns of Psychotropic Drug Prescription for U.S. Patients With Diagnoses of Bipolar Disorders
Baldessarini et al.
Psychiatr. Serv. 2007;58:85-91.
ABSTRACT | FULL TEXT  

Treatment-Resistant Bipolar Disorder
Gitlin
Focus 2007;5:49-63.
ABSTRACT | FULL TEXT  

Predictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
Perlis et al.
Focus 2006;4:553.
FULL TEXT  

'Switching' in bipolar disorder
Symonds
Adv. Psychiatr. Treat. 2006;12:306-307.
FULL TEXT  

Hypomania in clinical practice
Smith and Ghaemi
Adv. Psychiatr. Treat. 2006;12:110-120.
ABSTRACT | FULL TEXT  

Relapse prevention in bipolar disorder: a critical review of current guidelines.
McAllister-Williams
J Psychopharmacol 2006;20:12-16.
ABSTRACT  

Treatment-Resistant Bipolar Depression: A STEP-BD Equipoise Randomized Effectiveness Trial of Antidepressant Augmentation With Lamotrigine, Inositol, or Risperidone
Nierenberg et al.
Am. J. Psychiatry 2006;163:210-216.
ABSTRACT | FULL TEXT  

Predictors of Recurrence in Bipolar Disorder: Primary Outcomes From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
Perlis et al.
Am. J. Psychiatry 2006;163:217-224.
ABSTRACT | FULL TEXT  

Clinical Course of Children and Adolescents With Bipolar Spectrum Disorders
Birmaher et al.
Arch Gen Psychiatry 2006;63:175-183.
ABSTRACT | FULL TEXT  

Psychosocial Disability in the Course of Bipolar I and II Disorders: A Prospective, Comparative, Longitudinal Study
Judd et al.
Arch Gen Psychiatry 2005;62:1322-1330.
ABSTRACT | FULL TEXT  

Metabolism, lifestyle and bipolar affective disorder
Morriss and Mohammed
J Psychopharmacol 2005;19:94-101.
ABSTRACT  

A Randomized, Double-Blind, Placebo-Controlled Trial of Quetiapine in the Treatment of Bipolar I or II Depression
Calabrese et al.
Am. J. Psychiatry 2005;162:1351-1360.
ABSTRACT | FULL TEXT  

Is Your Depressed Patient Bipolar?
Kaye
J Am Board Fam Med 2005;18:271-281.
ABSTRACT | FULL TEXT  

A Pilot Study of Standardized Treatment in Geriatric Bipolar Disorder
Gildengers et al.
AJGP 2005;13:319-323.
ABSTRACT | FULL TEXT  

Screening for Bipolar Disorder in a Primary Care Practice
Das et al.
JAMA 2005;293:956-963.
ABSTRACT | FULL TEXT  

The Mood Spectrum in Unipolar and Bipolar Disorder: Arguments for a Unitary Approach
Cassano et al.
Focus 2005;3:61-68.
ABSTRACT | FULL TEXT  

Efficacy of Valproate Maintenance in Patients With Bipolar Disorder and Alcoholism: A Double-blind Placebo-Controlled Study
Salloum et al.
Arch Gen Psychiatry 2005;62:37-45.
ABSTRACT | FULL TEXT  

Advancing the pharmacological treatment of bipolar depression
Frangou
Adv. Psychiatr. Treat. 2005;11:28-37.
ABSTRACT | FULL TEXT  

Antidepressants for Bipolar Depression: A Systematic Review of Randomized, Controlled Trials
Gijsman et al.
Am. J. Psychiatry 2004;161:1537-1547.
ABSTRACT | FULL TEXT  

The Mood Spectrum in Unipolar and Bipolar Disorder: Arguments for a Unitary Approach
Cassano et al.
Am. J. Psychiatry 2004;161:1264-1269.
ABSTRACT | FULL TEXT  

Bipolar II Disorder Is Chronic
JWatch Psychiatry 2003;2003:1-1.
FULL TEXT