-- Robert Preidt
MONDAY, Dec. 6 (HealthDay News) -- People with depression who
also have psychotic-like symptoms, such as hearing voices or
believing others are plotting against them, are less likely to
respond to antidepressants, a new study finds.
It also found that bipolar disorder does not appear to be
associated with treatment resistance in patients with depression, a
finding that challenges the common theory that some cases of
difficult-to-treat depression are actually unrecognized bipolar
disorder, the researchers added.
They conducted the study to assess the link between bipolar
disorder and treatment outcomes among 4,041 patients with
depression. The patients first received the antidepressant
citalopram (Celexa), followed by up to three next-step treatments,
depending on their responses.
At the start of the study, 1,198 (30 percent) of the patients
said they had experienced at least one psychotic symptom -- such as
believing they had special powers or were being controlled or
plotted against -- in the previous six months. These patients were
significantly less likely to respond to treatment.
In addition, 1,524 patients (38.1 percent) said they had
experienced at least one symptom of bipolar disorder in the
previous six months. Of those symptoms, irritability was associated
with poor treatment outcomes.
But several indicators commonly associated with bipolar disorder
-- including history of manic symptoms and family history of the
condition -- were not associated with patient responses to
antidepressants, the researchers said.
The study was published online Dec. 6 in the
Archives of General Psychiatry.
"Considered as a whole, our results cast doubt on the frequent assertion that unrecognized bipolar disorder is widespread in clinical practice and particularly in treatment-resistant major depressive disorder," the researchers, led by Dr. Roy H. Perlis, of Massachusetts General Hospital and Harvard Medical School, concluded in a news release from the journal.
"Screening for bipolar disorder among psychiatric patients remains important, as does considering individual risk factors such as family history or age at onset. Still, our findings indicate that, in most individuals presenting with a major depressive episode without a prior manic or hypomanic episode, unrecognized bipolarity does not appear to be a major determinant of treatment resistance," the researchers said.
The U.S. National Institute of Mental Health has more about
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