People with depression experience brief episodes of mild mania

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Some researchers claim that we may have underestimated the number of people in the general population suffering from bipolar disorder and now a new study backs up this claim.

The research report from the US National Institute of Mental Health (NIMH) suggested that almost 40 percent of all those suffering from major depression in the US also have episodes of mania. These episodes are happening repeatedly but are mild and only last a few days at a time whereas true mania is more severe and lasts at least a week.

The researchers are referring to this milder mania as “sub-threshold hypomania” which means it’s below the threshold for being picked up as bipolar disorder.

“With hypomania, people may be more active and energetic than usual, and they may sleep less and become agitated more easily,” said the study’s senior author, Professor Kathleen Merikangas, a senior investigator at the NIMH in Bethesda, Md.

“The behavior is definitely different than their usual state, but it doesn’t cause impairment in their lives.”

Merikangas and her colleagues analyzed data from a survey of more than 5,000  households in the US who had responded to the National Comorbidity Survey Replication (NCS-R), a nationally representative face to face survey of American adults ages 18 years of age and older.

They found that people who had sub-threshold mania were more likely to suffer from anxiety, substance abuse and behaviour problems, and had more depressive episodes and attempted suicides than those who had major depression but who did not have sub-threshold mania. Interestingly, they were also just as likely as people with bipolar disorder to have a family history of mania.

Those with sub-threshold mania may benefit more from different treatment but at the moment may not get this treatment because they wouldn’t meet the criteria for bipolar disorder.

The researchers are supporting a proposal to broaden the diagnostic criteria for bipolar disorder for the next edition of the Diagnostic and Statistical Manual for Mental Diseases (DSM-IV) which is expected in three years time.

“Such an expansion of the bipolar concept would likely lead to important changes in the treatment of patients who are undiagnosed or misdiagnosed despite elevated morbidity and mortality rates” wrote the researchers in their paper.

The findings were published this month in the online ahead of print edition of the American Journal of Psychiatry.

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