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The Prevalence and Diagnostic Validity of Short-Duration Hypomanic Episodes and Major Depressive Episodes

  • Psychiatric Diagnosis (MB First, Section Editor)
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Abstract

Current diagnostic criteria for a hypomanic episode, as outlined in both the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-5), require a minimum duration of four consecutive days of symptoms of mood elevation. The 4-day criterion for duration of hypomania has been challenged as arbitrary and lacking empirical support, with many arguing that shorter-duration hypomanic episodes are highly prevalent and that those experiencing these episodes are clinically more similar to patients with bipolar disorder than to those with unipolar major depressive disorder. We review the current evidence regarding the prevalence, diagnostic validity, and longitudinal illness correlates of shorter-duration hypomanic episodes and summarize the arguments for and against broadening the diagnostic criteria for hypomania to include shorter-duration variants. Accumulating findings suggest that patients with major depressive episodes and shorter-duration hypomanic episodes represent a complex clinical phenotype, perhaps best conceptualized as being on the continuum between those with unipolar depressive episodes alone and those with DSM-5-defined bipolar II disorder. Further investigation is warranted, ideally involving large prospective, controlled studies, to elucidate the diagnostic and treatment implications of depression with shorter-duration hypomanic episodes.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

    Shefali Miller & Trisha Suppes

  2. Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA

    Ellen B. Dennehy

  3. Eli Lilly and Company, Indianapolis, IN, USA

    Ellen B. Dennehy

  4. VA Palo Alto Health Care System, Palo Alto, CA, USA

    Trisha Suppes

Authors
  1. Shefali Miller
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  2. Ellen B. Dennehy
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  3. Trisha Suppes
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Corresponding author

Correspondence to Shefali Miller.

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Conflict of Interest

Shefali Miller has received research grants from Merck and Sunovion.

Ellen B. Dennehy is employed by Eli Lilly and Company.

Trisha Suppes reports sources of funding or medications for clinical grants from the National Institute of Health, Sunovion Pharmaceuticals, Inc., Elan Pharma International Limited, and VA Cooperative Studies Program as well as fees for consulting agreements/advisory boards/speaking engagements from Sunovion Pharmaceuticals, Inc., A/S H. Lundbeck, Merck, and Astra Zeneca. Dr. Suppes has also received honoraria payments from the International Society of Bipolar Disorders (ISBD) Columbia, Continuing Medical Education, Healthmatters CME, Omnia-Prova Education Collaborative, Inc., Medscape, and the American Academy of Clinical Psychiatrists. She has also received royalties from Jones and Bartlett and UpToDate and paid travel expenses from Sunovion Pharmaceuticals, Inc., A/S H. Lundbeck, Omnia-Prova Education Collaborative, Inc., the American Psychiatric Association, the International Society of Bipolar Disorders (ISBD) Columbia, Astra Zeneca, and Merck.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Psychiatric Diagnosis

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Miller, S., Dennehy, E.B. & Suppes, T. The Prevalence and Diagnostic Validity of Short-Duration Hypomanic Episodes and Major Depressive Episodes. Curr Psychiatry Rep 18, 27 (2016). https://doi.org/10.1007/s11920-016-0669-2

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  • DOI: https://doi.org/10.1007/s11920-016-0669-2

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