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BPD in Medication-Free Young Subjects with MDD

J Psych Res; 2019 Mar; Koirala, Hu, et al

A substantial proportion of young subjects with major depressive disorder (MDD) share characteristics of bipolar disorder (BPD), a recent study found. Therefore, these high-risk (HRMDD) subjects, if treated with antidepressants, need to be monitored for development of BPD. 106 young (aged 15–30 years), medication-free subjects with MDD (HRMDD, n=51; [low-risk] LRMDD, n=55) were compared with 32 BPD (Type I: 14; Type II: 18) as well as 49 healthy controls (HCs). In MDD subjects, the effect of open-label antidepressant treatment for up to 24 months with periodic assessments was compared between HRMDD and LRMDD groups for treatment response, remission and (hypo)mania switch while controlling for attrition. Researchers found:

  • Significant gradation from LRMDD to HRMDD to BPD groups was found for increasing occurrence of alcohol dependence, comorbid posttraumatic stress disorder (PTSD), borderline personality traits, and occurrence of melancholic features.
  • Antidepressant treatment response was similar between the 2 groups except that for the 12-month period HRMDD showed a trend for a lower response.
  • Switch to (hypo)mania was infrequent in both groups though the HRMDD showed a higher occurrence of spikes in (hypo)mania symptoms.


Koirala P, Hu B, Altinay M, et al. Sub-threshold bipolar disorder in medication-free young subjects with major depression: Clinical characteristics and antidepressant treatment response. J Psych Res. 2019;110:1-8. doi:10.1016/j.jpsychires.2018.12.006.