- Higher Bipolarity Index scores were associated with use of mood stabilisers and/or second-generation antipsychotics rather than antidepressant monotherapy in stable MDD outpatients.
- ROC analysis identified a BI cutoff of 16 (AUC 0.765), with 69.4% sensitivity and 77.8% specificity for MS/SGA prescription.
- Results represent cross-sectional prescription patterns and do not constitute evidence that mood stabilisers or SGAs are preferable; prospective studies are required.
Int J Bipolar Disord. 2026 Jun 6. doi: 10.1186/s40345-026-00428-8. Online ahead of print.
ABSTRACT
BACKGROUND: Patients with major depressive disorder (MDD) who exhibit high bipolarity are at increased risk of future diagnostic conversion to bipolar disorder. However, treatment recommendations for MDD with bipolarity are constrained by limited direct evidence. We examined the association between bipolarity and primary pharmacotherapy in long-term stable outpatients with MDD and explored a clinically useful Bipolarity Index (BI) threshold.
METHODS: In this two-center cross-sectional study, participants were classified into an antidepressant (AD) group or a mood stabilizer/second-generation antipsychotic (MS/SGA) group. Bipolarity was assessed with the BI. Receiver operating characteristic (ROC) analysis was used to identify a BI cutoff discriminating MS/SGA from AD.
RESULTS: Of 103 participants, 54 were assigned to the AD group and 49 to the MS/SGA group. The BI score was significantly higher in the MS/SGA group than in the AD group (24.1 ± 12.9 vs 13.3± 7.0; p < 0.001). ROC analysis indicated a BI cutoff of 16 (Area Under the Curve = 0.765), yielding 69.4% sensitivity and 77.8% specificity for identifying the MS/SGA group.
CONCLUSION: Among long-term stable outpatients with MDD, higher BI scores were associated with the use of MS and/or SGA rather than antidepressant monotherapy as primary pharmacotherapy. In this Japanese stable outpatient sample, a BI score of 16 or above identified patients who were more likely to be receiving MS and/or SGA. These findings reflect prescription patterns observed in this cross-sectional sample and should not be interpreted as evidence that MS and/or SGA are preferable treatments for patients with greater bipolarity. Further prospective studies are needed to clarify the clinical significance of BI-defined bipolarity and its relationship to treatment outcomes in patients with MDD.
PMID:42250190 | DOI:10.1186/s40345-026-00428-8
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