There is an association between affective lability and both mixed and atypical depression, suggesting that the latter two may exist on the same continuum, according to study data published in the Journal of Clinical Psychiatry.

Investigators conducted a post-hoc analysis of BRIDGE-II-MIX, a cross-sectional study of 2811 patients experiencing a major depressive episode in the context of bipolar I, bipolar II, or major depressive disorder. The study was conducted at 239 centers across 3 continents between June 2009 and July 2010. Sociodemographic and psychiatric variables were reported for each patient, including functional status and illness severity.

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The post-hoc analysis cohort comprised 2577 patients experiencing a major depressive episode, among whom 694 (26.9%) presented with affective lability vs those without affective lability (n=1883). Similarly, a comparison was conducted between patients with (n=1035) and without (n=1542) mixed features in their depressive episode. Stepwise backward logistic regression models were performed to assess affective lability and mood reactivity as clinical features of mixed depression. Affective lability was defined by the BRIDGE-II-MIX steering committee as a combination of existing classifications; mood reactivity was identified using criteria specified by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

In this cohort, affective lability was positively associated with bipolar disorder type I (odds ratio [OR], 2.1; 95% CI, 1.62-2.79) and bipolar disorder type II (OR, 2.2; 95% CI, 1.58-3.04) and negatively associated with major depressive disorder (OR, 0.4; 95% CI, 0.34-0.54). Patients with affective lability also had major depressive disorder with DSM-5 mixed features (OR, 10.5; 95% CI, 7.10-15.49) and major depressive disorder with DSM-5 atypical features (OR, 2.7; 95% CI, 1.92-3.64) more frequently.

Affective lability was associated with higher severity of mania (P <.001) and lower severity of depression (P =.004). In logistic regression models, mood reactivity was the variable most significantly associated with affective lability, and vice versa (both P <.001). Additional variables associated with mood reactivity were the presence of DSM-5 mixed features (OR, 1.5; 95% CI, 1.21-1.76), leaden paralysis (OR, 1.6; 95% CI, 1.29-1.92), hyperphagia (OR, 1.4; 95% CI, 1.05-1.77), hypersomnia (OR, 1.3; 95% CI, 1.05-1.71), and comorbid anxiety disorders (OR, 1.5; 95% CI, 1.20-1.80).

Given these results, affective lability may have merit as a diagnostic criterion for depressive states with mixed features. Researchers suggested further research on the relationship between affective lability and mood reactivity as a means to understand mixed and atypical depression.

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Verdolini N, Menculini G, Perugi G, et al. Sultans of swing: a reappraisal of the intertwined association between affective lability and mood reactivity in a post hoc analysis of the BRIDGE-II-MIX study. J Clin Psychiatry. 2019;80(2):17m12082.