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Letters to the Editor |

BRIDGE Study Warrants Critique—Reply

Allan H. Young, MD; Jules Angst, MD; Jean-Michel Azorin, MD; Eduard Vieta, MD; Guilio Perugi, MD; Alex Gamma, PhD; Charles L. Bowden, MD
Arch Gen Psychiatry. 2012;69(6):644-645. doi:10.1001/archgenpsychiatry.2012.120.
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We are pleased to respond to the points raised by Allen et al, some of which take material out of context and quote news media articles beyond our control. For example, the letter states that “The message is that almost half the patients with a major depressive episode have undiagnosed bipolar disorder and are ‘not receiving necessary mood stabilizer treatment.’” Our actual statements are:

They assert that “The study's findings are based on a ‘bipolar specifier’ requiring ‘no minimum duration of symptoms’ and ‘no exclusion criteria,’” and that “Any subject who came to psychiatric attention with an angry, agitated, or elated response to environmental triggers or psychoactive substances might have met criteria for ‘bipolarity.’” The criteria, stated in the “Methods” section of our article,1(p793) were (1) an episode of elevated mood, an episode of irritable mood, or an episode of increased activity with (2) at least 3 of the symptoms listed under Criterion B of the DSM-IV-TR associated with (3) at least 1 of the 3 following consequences: unequivocal and observable change in functioning uncharacteristic of the person's usual behavior, marked impairment in social or occupational functioning observable by others, or requiring hospitalization or outpatient treatment. The minimum duration of symptoms required for a hypomanic episode was 1 day. We assessed the duration reported for hypomanic episodes in 5 groups. Among subjects with major depressive episode with hypomanic episodes, 7.8% reported episodes of 1 day's duration; 2 to 3 days' duration was more frequent than 4 to 6 days.2 No exclusion criteria for manic/hypomanic episodes associated with antidepressant or other drug use were applied. Importantly, the initial eligibility criterion was that patients have presented to clinical settings for evaluation and treatment of a major depressive episode per DSM-IV-TR criteria. These sequential criteria, applied by senior psychiatrists in each country, are entirely inconsistent with the assertion that the psychiatrists conducting the assessments enrolled “any subject who came to psychiatric attention with an angry, agitated, or elated response to environmental triggers.”


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June 1, 2012
David M. Allen, MD; Peter I. Parry, MBBS, FRANZCP; Robert Purssey, MBBS, FRANZCP; Glen I. Spielmans, PhD; Jon Jureidini, PhD, MBBS, FRANZCP; Nicholas Z. Rosenlicht, MD; David Healy, MD; Irwin Feinberg, MD
Arch Gen Psychiatry. 2012;69(6):643-645. doi:10.1001/archgenpsychiatry.2012.118.
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