Introduction: Irritable mood (IM) and subthreshold hypomanic symptoms are reported in half and two-fifths of major depressed subjects respectively, but their clinical and prognostic meanings remain unclear. The aim of this study was to test the clinical usefulness of 2 specifiers in DSM-IV major depressive disorder (MDD): IM occurring during an index episode (IM+) and lifetime episodes of elated mood or IM with at least 2 concurrent hypomanic symptoms (subthreshold hypomanic episodes [SHEs]). Method: We included 482 outpatients with MDD participating in the Combining Medications to Enhance Depression Outcome study (mean age 43.14 ± 12.46 years, 144 males – 30%). The main aim of the original study was to test whether 2 different medications when given in combination as the first treatment step, compared to 1 medication, would improve antidepressant response. Results: IM + subjects (N = 349; 70%) were younger and more often females, with a more severe depression, a more marked social impairment, and more psychiatric comorbidities. The IM + group was also characterized by higher levels of suicidal ideation and more cases of emotional abuse. The combination of IM+ and SHEs was associated with an even more severe clinical picture. Limitations include the post hoc method, incomplete assessment of bipolar validators (e.g., family history of bipolar illness), personality disorders and suicide attempts. Conclusions: The presence of IM and SHEs in MDD correlate with an overall more severe clinical condition.
Neuropsychobiology

中文翻译：

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易怒情绪和亚阈值轻躁狂发作与更严重的重度抑郁症相关

简介：有一半和五分之二的重度抑郁症受试者分别报告了易激惹（IM）和阈下轻躁狂症状，但它们的临床和预后意义仍不清楚。本研究的目的是测试 DSM-IV 重度抑郁症 (MDD) 中 2 个说明符的临床实用性：在指数发作期间发生的 IM (IM+) 和终生情绪高涨的发作或 IM 至少有 2 个并发轻躁狂症状 (阈下轻躁狂发作 [SHE]）。方法：我们纳入了 482 名 MDD 门诊患者，参与了联合用药以增强抑郁症结果研究（平均年龄 43.14 ± 12.46 岁，144 名男性 – 30%）。最初研究的主要目的是测试两种不同的药物在作为第一个治疗步骤联合使用时，与一种药物相比，是否会改善抗抑郁反应。结果： IM+受试者（N= 349; 70%) 更年轻，更常见的是女性，患有更严重的抑郁症、更明显的社交障碍和更多的精神疾病。IM + 组的特点还包括更高水平的自杀意念和更多的情感虐待案例。IM+ 和 SHE 的组合与更严重的临床表现相关。局限性包括事后方法、对双相情感验证者的不完整评估（例如，双相情感障碍家族史）、人格障碍和自杀未遂。结论： MDD 中 IM 和 SHE 的存在与整体更严重的临床状况相关。
神经心理生物学