Unipolar and bipolar difference in seasonal affective disorder: dexamethasone suppression Test

Abstract

Objective: The primary aim of this study is to determine whether there is any difference in Dexamethasone Suppression Test (DST) between unipolar and bipolar cases with seasonal course. Methods: Cases with seasonal affective disorder (SAD) (exhibiting seasonal course during SCID-I diagnostic interview, which is a longitudinal course determinant according to DSM-IV) that filled the informed consent form during their recovery period were taken into this study consecutively, during their clinic follow up. The average of age of 14 unipolar cases (13 female, 1 male) was 51.2±8.7; while the average of age of bipolar cases (6 female, 1 male) was 44.3±5.2 year. Results: Inability to be suppressed with DBT was more frequent in bipolar cases with seasonal course (100%) than unipolar cases (42.8%). Although the ratio of female/male is similar between unipolar and bipolar SAD cases, bipolar cases are younger. In bipolar SAD, childhood trauma and premenstrual syndrome were reported more often, but previous stressor and social support before the first episode were less frequent. The first episode type in all of the bipolar cases was depressive period. In bipolar group, age of onset and age of starting prophylactic treatment were earlier, period until diagnosis was longer, episode severity was more, number of episodes was higher, but episode duration was shorter and functionality scores were higher. In bipolar cases total remission between episodes was 100%, treatment adherence was 92.9%. Bipolar disorder, childhood trauma, PMS, and severe episode were found as determinants of DST negativity in SAD based on regression analysis. Conclusion: This study was the first one to compare unipolar and bipolar cases in seasonal affective disorder and found important differences. While HPA axis irregularity is expected in light reactive SAD cases, that have characteristic atypical vegetative symptoms during the depressive periods and severe depressive periods pose resistant challenge to treatment, in bipolar SAD cases it may be usual. Another important result of the study was that, seasonal affective disorder cases with insuppressible cortisol levels with DST showed better clinical course than the other group.

Keywords

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Mevsimsel Mizaç Bozukluğunda Tek Uçlu ve İki Uçlu Farkı: Deksametazon Baskılama Testi

Abstract

Amaç: Bu çalışmanın birincil amacı mevsimsel gidiş gösteren tek uçlu ve iki uçlu olgular arasında deksametazon baskılama testi’nde (DBT) fark olup olmadığının saptanmasıdır. Yöntem: Mevsimsel mizaç bozukluğu (MMB) olan (SCID-I ile yapılan tanı görüşmesinde DSM-IV’e göre uzunlamasına gidiş belirleyicisi olarak mevsimsel gidiş gösteren) ve bilgilendirilmiş onam formunu onaylayan, iyilik dönemindeki olgular, olağan poliklinik izlemleri sırasında, ardışık olarak çalışmaya alınmıştır. Bulgular: DBT ile baskılanamama mevsimsel gidiş gösteren iki uçlu olgular arasında (%100) tek uçlu olgulardan (%42.8) daha sıktı. Tek uçlu ve iki uçlu MMB olan olgularda kadın/erkek oranı benzer iken, iki uçlu olgular daha gençtti. İki uçlu MMB’de çocukluk çağı travması ve premenstrüel sendrom (PMS) daha sık iken, ilk hecme öncesi stresör ve sosyal destek iki uçlu olgularda daha az sıklıkta idi. İlk hecme tipi iki uçlu olguların tümünde depresif dönemde idi. İki uçlu bozukluk (İUB) grubunda başlangıç yaşı ve koruyucu sağaltım başlangıç yaşı iki uçlu grupta daha erken, tanı için geçen süre daha uzun, hecme şiddeti daha yüksek, hecme sayısı daha fazla olmasına karşılık hecme süresi daha kısa, işlevsellik puanları daha yüksek bulundu. İki uçlu olgularda hecmeler arası tam düzelme %100, sağaltıma uyum %92.9 oranında id. İki uçlu bozukluk, çocukluk çağı travması, PMS ve ağır şiddette hecme, regresyon analizinde MMB’da DBT (-)’liğinin öngörücüleri olarak saptandı. Sonuç: Bu çalışma mevsimsel mizaç bozukluğunda tek uçlu ve iki uçlu olguları karşılaştıran ilk çalışmadır ve önemli farklar ortaya koymaktadır. Karakteristik atipik vejetatif belirtilerin depresif dönemlere damgasını vurduğu, şiddetli depresif dönemlerin tedaviye direnç oluşturduğu, ışığa reaktif MMB olgularında HPA eksen düzensizliği beklenir bir durumken, MMB iki uçlu olgularında ise mutad gibi görünmektedir. Bir diğer önemli sonuç, DBT ile kortizol düzeyi baskılanamayan MMB olgularının diğerlerinden daha iyi gidiş özellikleri gösteriyor oluşudur.

Keywords

• mevsimsel mizaç bozukluğu, tek uçlu bozukluk, iki uçlu bozukluk, deksametazon baskılama testi

References

1. Rosenthal NE. Issues for DSM-V: Seasonal affective Disorder and Seasonality. Am J Psychiatry. 2009; 163: 852-853.
2. Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Davenport Y, Mueller PS, Newsome DA, Wehr TA. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry. 1984; 41: 72-80.
3. Boyce A, Barriball BS. Circadian rythms and depression. Aust Fam Physician. 2010; 39: 307-310.
4. Ghadirian AM, Marcouitz S, Murphy BE. Seasonal bipolar disorder exaserbated by Cushings Disease. Compr Psychiatry. 2005; 46: 155-158.
5. First MB, Spitzer RL, Gibbon M (1997) Structured Clinical Interview for DSM-IV Clinical Version (SCID-I / CV), Washington DC, American Psychiatric Press.
6. Çorapçıoğlu A, Aydemir Ö, Yıldız M. DSM-IV Eksen I Bozuklukları (SCID-I) İçin Yapılandırılmış Klinik Görüşme, Klinik Versiyon. Ankara, Hekimler Yayın Birliği 1999.
7. Özerdem A, Yazıcı O, Tunca Z. Mood Disorders Study Group, Psychiatric Association of Turkey and K Tırpan. Establishment of Computerized Registry Program for Bipolar Illnes in Turkey: SKİPTÜRK. J Affect Disord. 2004; 84: 82-86.
8. Rosen LN, Targum SD, Terman M, Bryant MJ, Hoffman H, Kasper S, et al. Prevalence of seasonal affective disorder at four latitudes. Psychiatry Res. 1990; 31: 141-144.

9. Kennedy N, Boydell J, Kalidindi S. Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. Am J Psychiatry. 2005; 162: 257262.
10. Kessing LV. Gender differences in the phenomenology of bipolar disorder. Bipolar Disord. 2004; 6: 421-425.
11. Sullivan B, Payne TW. Affective disorders and cognitive failures: a comparison of seasonal and nonseasonal depression. Am J Psychiatry. 2007; 164: 1663–1667.
12. Wehr TA, Duncan WC Jr, Sher L, Aeschbach D, Schwartz PJ, Turner EH, Postolache TT, Rosenthal NE. A circadian signal of change of season in patients with seasonal affective disorder. Arch Gen Psychiatry. 2001; 58: 1115-1116.
13. Ellenbogen MA, Hodgins S. Structure provided by parents in middle childhood predicts cortisol reactivity in adolescence among the offspring of parents with bipolar disorder and controls. Psychoneuroendocrinology. 2009; 34: 773-785.
14. Cassidy F, Ritchie JC, Carroll BJ. Plasma dexamethasone concentration and cortisol response during manic episodes. Biol Psychiatry. 1998; 43:747-754.
15. Watson S, Gallagher P, Ritchie JC, Ferrier IN, Young AH. Hypothalamic-pituitary-adrenal axis function in patients with bipolar disorder. Br J Psychiatry. 2004; 184: 496-502.
16. Vinberg M, Bennike B, Kyvik KO, Andersen PK, Kessing LV. Salivary cortisol in unaffected twins discordant for affective disorder. Psychiatry Res. 2008; 161: 292-301.
17. Pendse BP, Engstroem G, Traeskman-Bendz L. Psychopathology of seasonal affective disorder patients in comparison with major depression patients who have attempted suicide. J Clin Psychiatry. 2004; 65: 322-327.
18. Schüle C. Neuroendocrinological mechanisms of actions of antidepressants. J Neuroendocrinol. 2007; 9: 213-226.
19. Modell JG, Rosenthal NE, Harriett AE, Krishen A, Asgharian A, Foster VJ, Metz A, Rockett CB, Wightman DS. Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL. Biol Psychiatry. 2005; 58: 658-667.