Depression with racing thoughts

Abstract 

The aim of this study was to explore the clinical and family history correlates of depression with racing thoughts, an understudied phenomenon. Consecutive outpatients with a major depressive episode (MDE, N=336; unipolar subtype, n=130; bipolar-II subtype, n=206) were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version. Depression with racing thoughts was present in 213 patients (63.3%), a subgroup characterized by significantly more patients with bipolar-II disorder, lower age and lower age of onset, more atypical features, psychomotor agitation, diminished ability to think, suicidal ideation, guilt, leaden paralysis, MDE symptoms, and bipolar-II disorder family history than found in the subgroup without racing thoughts. Logistic regression controlled the diagnosis of bipolar-II disorder (which was associated with most of these variables). Comparisons in the separate bipolar-II and unipolar samples of depression with racing thoughts vs. the variables found significantly different in the total group found that associations with depression with racing thoughts were partly related to bipolar-II and partly related to unipolar diagnoses. Limitations of the study include reliance upon a single interviewer, non-blind cross-sectional assessment and bipolar-II diagnosis based on history. Depression with racing thoughts was very common in depressed outpatients, and was associated with suicidal ideation. Possible differential effects of antidepressants vs. mood stabilizers and antipsychotics are discussed.

Keywords: Major depressive episode, Bipolar-II subtype, Unipolar subtype, Suicide