May comorbidity of atypical major depressive episode and social phobia be a predictor for a possible switch to mania or hypomania in individuals diagnosed with cyclothymic disorder?

It has been suggested that an important part of major depressive episodes (MDE) could be in the bipolar spectrum. However, because “soft” bipolar symptoms are clinically not adequately questioned, these features are overlooked in practice. It has been reported that approximately one-third of MDEs have cyclothymia in addition to major depressive episodes (BP-II ½). Manic/hypomanic switches occur more often in these patients under antidepressant treatments. In this report, we present five cases of depressive episode patients with cyclothymic disorder who had hypomanic switch under antidepressant treatment. We will also discuss whether factors like atypical phenomena and seasonal pattern of depression, and comorbid social phobia in this patient group could be a predictor of switch.