Depressive polarity at illness onset is associated with lifetime suicide attempts in euthymic bipolar outpatients.

Introduction: Differential characteristics related to first illness episode in bipolar disorder (BD) have been identified based on the current literature; however, evidence are currently inconsistent across studies. Objectives: Thus, this study aimed to identify whether first depressive episode (FDE) was associated with specific clinical correlates in a large sample of BD outpatients. Methods: The sample included 364 euthymic bipolar outpatients (mean age= 53.9±16.05) of which 229 (62.9%) with FDE and 135 (37.1%) with first non-depressive episode (FNDE). A detailed data collection was performed and illness histories were retraced through clinical files and lifetime computerized medical records. Results: Compared to patients with FNDE, those with FDE significantly differ regarding age (p ≤.001), educational level (p ≤.05), working status (p ≤.01), and body mass index (p ≤.05). They were also more likely to have a older age at illness onset (p ≤.005) and first treatment (p≤.001), recent melancholic characteristics (p≤.05) and more lifetime suicide attempts (p ≤.05), use of non psychiatric medications in the past (p ≤.05), and have experienced a recent manic episode (p ≤.05). After logistic regression analysis adjusting for age, educational level, and working status, FDE was associated with recent melancholic features (OR≤.065, p≤.01), and lifetime suicide attempts (OR≤8.334, p≤.05). Conclusions: The identification of early targets for treatment may be very useful in the stratification of different BD phenotypes in the clinical practice. The presence of FDE seems to identify a specific subgroup of BD outpatients exhibiting differential clinical characteristics. [ABSTRACT FROM AUTHOR]