Fig. 1.

Flow-chart for cohort. Of the initial 550 National Institute of Mental Health Collaborative Depression Study (CDS) participants with unipolar major depression on intake and at least one year of follow-up, a total of 108 experienced a prospectively observed hypomania or mania (H/M) as previously reported after a median follow-up of 19.9 years (20). This manuscript reports on the subsequent follow-up of these 108 individuals after an additional follow-up for a median of 13.3 (mean of 14.4) years, during which 60 experienced a subsequent hypomania. The figure details the number of these whose initial prospectively observed hypomanic or manic (H/M) episode was associated with treatment (Rx-associated) or occurred in the setting of a positive family history of bipolar disorder.