Depression with unipolar and bipolar course in primary care setting: clinical, behavioral features and treatment outcomes

Abstract

Objectives. The study pursued 2 objectives: 1) to identify clinical and behavioral features of bipolar depression (BD) in comparison with unipolar depression within first depressive episode (DE) and recurrent depressive disorder (RDD); 2) to estimate effectiveness of standard antidepressant therapy in bipolar and unipolar depression in primary care setting. Materials and methods. Study was conducted in primary care institutions in two phases. On first phase 71 depressed patient was recruited (mean age 52,1 ± 14,9) with diagnosis DE (N = 22), RDD (N = 36) and bipolar affective disorder (BAD) (N = 13). Clinical evaluation was performed by means of Clinical Interview for Depression and Related Syndromes (CIDRS), state dynamic was evaluated with Clinical Global Impression scale (CGI). Behavioral features were registered with Multiphasic Personality Inventory. On the second phase of the study 46 patients received antidepressant therapy (sertraline 75–100 mg) and were followed-up for 3 months to monitor their condition. Results. Groups of patients with DE and RDD were indistinguishable by clinical and behavioral parameters. In comparison with unipolar depression (UD) patients, BD patients had more severe anxiety, somatic (autonomic) symptoms, intropunitive disturbances, depersonalisation, suspiciousness, irritability and mood lability (p < 0,05 for all CIDRS items). Patients with BD had more complicated structure of behavioral disturbances as featured by MMPI results, including impulsivity, protest behaviors, tendency to overvalued ideas, impaired emotional regulation, empathic deficit and perception problems (p < 0,05 for corresponding MMPI scales). Highest response and remission rates were achieved in a group of patients with RDD (87,5 and 47,8 % respectively). Patients with DE had low response and low remission rates (46,7 and 13,3 % respectively). Patients with BP had somewhat high response rate but were unable to achieve a remission (75 and 0 % respectively). Conclusion. Depression with unipolar and bipolar course seen in primary care differ from each other by set of clinical and behavioral characteristics, and by level of response to antidepressant therapy. The results show that evaluation of depression and related psychopathology using different, complimentary methods, may contribute to more precise diagnosis of BAD. Further evaluation of current results requires prospective trials of longer duration with inclusion of higher number of participants, as well as considering a set of clinical and psychological characteristics that may potentially influence the treatment outcomes. Moreover, future research on BD treatment in primary care settings require comparison of effectiveness and safety of different treatment strategies.