Anxious distress specifier and bipolar spectrum: naturalistic prospective study on 241 patients with depressive episode

Major depression is a heterogeneous disorder and different specifiers have been defined by DSM-5. The aim of this study was to assess the presence of anxious distress specifier in a sample of 241 outpatients with major depressive episode in MDD, BD-I or BD-II, followed for a period of 12 weeks, treated with antidepressants, antipsychotics and mood stabilizer, and to evaluate its longitudinal predictive validity for clinical outcome. Diagnostic assessment was performed with SCID-5, SIMD, HAM-D, YMRS, CGI, Brief TEMPS-M, GAF and Koukopoulos’s criteria for mixed attenuated depression. Anxious distress specifier was present in 58.9% of the sample and compared with the group without the specifier this group had significant higher scores of YMRS, HDRS and CGI-s and a correlation with BD-II diagnosis, family history for bipolar disorder, previous hypomanic episodes, seasonal pattern, mixed features according to Koukopoulos’s criteria. The response from baseline to twelve weeks was in a significantly reduction of HDRS while for YMRS there was an increase. This treatment response was present also if the group with the specifier was separated by the group with mixed features (also attenuated). These results indicated a relationship with bipolar spectrum