Mood spectrum symptoms during a major depressive episode: Differences between 145 patients with bipolar disorder and 155 patients with major depressive disorder. Arguments for a dimensional approach.

BACKGROUND: Several studies have challenged the traditional unipolar-bipolar dichotomy in favor of a more dimensional approach. OBJECTIVE: To evaluate the differences in mood spectrum between patients with bipolar disorder (BD) and major depressive disorder (MDD) during a major depressive episode (MDE). METHOD: Study participants were 145 patients with BD and 155 patients with MDD recruited at three University Medical Centers in Italy. All study subjects met Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for MDE and completed the Mood Spectrum-Self-Report-Last Month questionnaire. RESULTS: Patients with BD endorsed more items in the mood manic/hypomanic and energy depressive subdomains of the MOODS-SR questionnaire. Significant differences were also found for specific depressive and manic items, which were more frequently endorsed by patients with BD. A large number of patients with BD, but also a considerable number of patients with MDD, endorsed manic items during a depressive episode. CONCLUSIONS: There are differences between BD and MDD in terms of the number and type of mood spectrum items that are endorsed during a MDE, which may help to identify patients with BD when a retrospective assessment of a history of mania or hypomania is not possible or not reliable. A high number of patients with BD and a considerable number of patients with MDD endorsed several items in the manic section of the mood, energy, and cognition domains, this confirming the centrality of mixed features in patients with mood disorders and the need for a unitary, dimensional, descriptive and dynamic approach to MDD and BD, such as the recently proposed ACE (Activity, Cognition, Energy) model.

[Antidepressant use in pregnancy: a critical review of the risk and benefits]. / Benefici e potenziali rischi dell'utilizzo di antidepressivi in gravidanza: una revisione della letteratura.

AIM: Pregnancy is considered a high-risk period for the development of a depressive disorder in women, particularly in those with a pre-existing affective disorder. The use of antidepressants in pregnancy may be responsible for congenital malformations and neonatal toxicity. The aim of the study is to review the literature examining the various antidepressants used in pregnancy and their relationship with the development of congenital malformation and neonatal diseases; in particular, we have focused on the evaluation of the risk/benefit in the administration of specific drugs, the possible teratogenicity and placental transfer. MATERIALS AND METHODS: We performed a computerized search of PubMed through the papers published from 1996 to 2014, identifying the studies that have showed a relationship between treatment with antidepressants in pregnancy and teratogenic effects and toxicity in the short and long term. RESULTS: The revision of the pharmacovigilance studies indicate that most of the selective serotonin reuptake inhibitors have a teratogenic risk substantially similar to that of unexposed controls. For other antidepressants (tricyclics, mirtazapine, venlafaxine, escitalopram, duloxetine) the evidences on the level of risk are still numerically inconsistent and need to be clarified by further research. CONCLUSIONS: Despite the lack of guidelines for the treatment of depressive disorders during pregnancy, clinically relevant data are continuing to accumulate in the literature. For many medications, compared to the past, we are now able to make a more rational and less approximate estimate of the risk/benefit ratio.