Sub-threshold manic symptoms in recurrent major depressive disorder are a marker for poor outcome

DJ Smith, L Forty, E Russell, S Caesar, J Walters, C Cooper, Ian Jones, Lisa Jones, N Craddock

Research output: Contribution to journalArticle

39 Citations (Scopus)


OBJECTIVE: A small but significant proportion of patients with major depressive disorder (MDD) report mild manic symptoms which are below the diagnostic threshold for a hypomanic episode. METHOD: We tested for an association between sub-threshold manic symptoms and clinical outcome in almost 600 patients with recurrent MDD who also had no known family history of bipolar disorder. RESULTS: 9.6% of this large sample had a life-time history of sub-threshold manic symptoms. These patients were significantly more likely to have a history of poor response to antidepressants (OR 2.84; 95% CI 1.23-6.56; P <0.02) and more likely to have experienced psychosis (OR 2.07; 95% CI 1.05-4.09; P <0.04). They had also experienced more depressive episodes on average (P = 0.006) and were more likely to have been admitted to hospital (P <0.03). CONCLUSION: Sub-threshold manic symptoms in patients with recurrent MDD may be a useful clinical marker for poor response to antidepressants and a more morbid long-term clinical course.
Original languageEnglish
Pages (from-to)325-329
Number of pages5
JournalActa Psychiatrica Scandinavica
Issue number4
Publication statusPublished - 1 Apr 2009


  • response
  • bipolar
  • antidepressants
  • depression
  • prognosis


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