Bipolar Disorder Disease Course Varies More Than Major Depressive Disorder, BPD

Among patients with major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD), patients with BD had the most rapidly fluctuating disease course, according to study results published in Journal of Affective Disorders.

Researchers conducted a prospective cohort study that comprised patients who sought treatment for major depressive episodes (MDEs) and were referred to the specialized psychiatric center at the University of Helsinki in Finland. Patients (N=95) were followed for 6 months for symptoms of depression or remission. The disease courses of the 3 conditions were compared and evaluated for predictors of time to first remission.

Study patients met criteria for inclusion into either the MDD group (n=39), BD group (n=33), or BPD (n=23) group. The patient groups comprised 53.85%, 75.76%, and 69.57% women; mean ages were 31.41, 32.92, and 27.98 years; Montgomery-Åsberg Depression Rating Scale (MADRS) scores were 15.69, 13.67, and 16.91 points; 2.92%, 10.64%, and 9.17% had mixed MDE (P <.001); and Young Mania Rating Scale (YMRS) scores were 0.64, 2.85, and 1.77 points (P =.049), respectively.

During follow-up, the average number of distinct mood states was 5.75, lasting a mean of 60.9 days. Stratified by diagnosis, the number of periods and lengths of episodes were 4.49 and 69.2 days for MDD, 8.03 and 40.30 days for BD, and 4.67 and 75.6 days for BPD, respectively. Although no significant differences in the number of episodes (P =.532) or duration (P =.939) were observed between disease groups, women experienced significantly more episodes (mean, 6.51; P =.002) than men (mean, 4.19; P =.002).

In the regression analysis, the number of distinct mood states was associated with BP (RR, 1.45; P =.0001), gender (relative risk [RR], 0.694; P =.0003), and BPD Severity Index (BPDSI) per point (RR, 0.988; P =.0186).

The time to first remission was significantly faster among patients with BD compared with MDD or BPD (P =.012). Stratified by patients with BD and patients without BD, patients with BD still had a faster time to remission than the cohort without BD (P =.049).

The time to first full remission was associated with BP diagnosis (hazard ratio [HR], 2.6314; P =.00403), Alcohol Use Disorders Identification Test score (HR, 1.0707; P =.01324), BPDSI (HR, 0.9494; P =.02341), and MADRS score (HR, 0.9087; P =.00654). Excluding the patients with BPD, BD (HR, 2.8951; P =.00543) and MADRS scores (HR, 0.9155; P =.02917) were associated with time to first full remission.

The major limitation of this study is the short follow-up duration.

Study authors concluded, “In this prospective 6-month cohort study of MDE patients in psychiatric care, there were differences between patient groups in how quickly a period of remission was reached; compared with unipolar depression, the time was shorter in depression in BD, but longer in patients with comorbid BPD. Switches from depression to full hypomanic or manic states seem uncommon in a 6-month time frame among (mostly type II) BD patients in outpatient care.”