Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

177 Agitated depression: spontaneous and inducedTable 7.2 Nosologic diagnosis of 212 patients according to sex and polarityMale Female Total %Bipolar I 20 36 56 27Bipolar II 15 51 66 31Unipolar depression 12 56 68 32MxD 14 8 22 10MxD, first episode of agitated (mixed) depression.2 weeks’ duration was required. All these patients were examined, evaluated, andtreated by the authors at the Centro Lucio Bini in Rome. The previous course of thedisorder, treatments, and present condition were evaluated with all available medicalrecords and with the cooperation of at least one family member. Table 7.2 shows thedistribution of these patients by gender and polarity of their previous course; the ageat first affective episode was 31.9 for women and 37.6 for men; the age at indexepisode of agitated depression was 44.9 for women and 44.5 for men. One hundredand eleven patients had had earlier episodes of agitated depression. The age at onsetof the first episode of agitated depression as first affective episode was 44.5 years.The mean Hamilton-D score was 23.8 (range 14–39) for all patients; 27.2 (range17–39) for patients with psychotic agitated depression; 25.3 (range 16–36) forcases with agitated depression (non-psychotic) with psychomotor agitation; and20.0 (range 14–32) for patients with minor agitated depression.The mean duration of the episodes of agitated depression was 4.6 months (range1–48 months).Spontaneous and induced agitated depressionThe episode started as an agitated depression in 99 (47%) cases. In the other 113(53%) cases, the episode started as a simple depression without symptoms ofagitation, and later it turned into an agitated depression. The mean duration of thesimple depression was 4.7 months (1–36 months). The shift from simple toagitated depression occurred in association with various treatments, mainly antidepressants,but also other treatments with stimulant effect (Table 7.3). The onsetof agitated depression took place either immediately or within a few days to a fewweeks. The great majority of agitated depressions emerged during treatment withtricyclic antidepressants (58 cases), selective serotonin reuptake inhibitors (45cases), other antidepressants (27 cases), and seven cases during maintenancetreatment with antidepressants. The small number of cases (four) associatedwith monoamine oxidise inhibitors is probably due to the limited use of these