Mood changes related to antidepressants: a longitudinal study of patients with bipolar disorder in a naturalistic setting (original) (raw)
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An Update on Antidepressant Use in Bipolar Depression.
Current Psychiatry Reports, 2012
The effective treatment of depression in people with bipolar disorder remains a clinical challenge. The role of antidepressant medication in treating bipolar depression has been controversial. While early studies and meta-analyses supported a role for antidepressant medication, more recent, high quality randomized controlled trials in bipolar depression have generally not demonstrated efficacy for antidepressant medications. Although the risk of affective switch and long-term de-stabilization remains a concern when using antidepressant medications in bipolar disorder, the magnitude of this risk has been difficult to ascertain with confidence. Maintenance use of antidepressant medication has generally not demonstrated a favorable risk-benefit ratio. Future studies should explore the patient characteristics and response patterns that predict a more favorable response profile to antidepressants amongst patients with bipolar disorder so that the medications can be rationally used in those who are most likely to benefit.
Bipolar depression: Clinical correlates of receiving antidepressants
Journal of affective disorders, 2012
BACKGROUND: The efficacy and tolerability of antidepressants (ADs) to treat or avoid episodes of depression in bipolar disorder (BPD) patients as well as reasons for using them remain unresolved. METHODS: We analyzed patient-characteristics and outcomes of episodes of acute major depression among 290 adult, DSM-IV BPD patients (71% type-I, 52% women) at the Hospital Clinic of Barcelona; 80% were given an AD and 20% were not; 80% of both groups also received mood-stabilizers. We evaluated factors associated with AD-treatment using bivariate analyses and multiple logistic-regression modeling. RESULTS: Factors associated with AD-use by multivariate modeling ranked: [a] more years ill, [b] depressive first-lifetime episode, [c] more depressions/year, [d] melancholic index episode, and [e] less affective illness in first-degree relatives. Within 8weeks, depression improved by ≥50%, less often among BPD patients given an AD (64.4%; 38.6% without switching into hypo/mania) than not (82.1%;...
Characteristics of bipolar disorder patients given antidepressants
Human Psychopharmacology: Clinical and Experimental, 2012
Evidence concerning efficacy of antidepressants in bipolar disorder remains inconsistent and inconclusive. As the appropriate clinical use for such patients remains unclear, we characterized outpatients with bipolar disorders who were or were not treated with antidepressants. Clinical data were collected systematically from consecutive outpatients in 11 participating Argentine mood-disorder clinics in 2007-2008. Diagnoses met DSM-IV criteria, supported by structured interviews based on the MINI-500. Of 338 outpatients diagnosed with bipolar I (45.0%), II (29.3%), or nototherwise-specified (NOS) (25.7%) disorder, 128 (37.9%) received antidepressants. Subjects given antidepressants or not did not differ significantly by presence or severity of current depression or being suicidal but were more likely to be women. Bipolar I disorder patients were three times less likely than types II or NOS to receive an antidepressant, with or without a mood-stabilizer or antimanic agent. Despite inconclusive evidence for efficacy and safety of antidepressants in various phases of bipolar disorders, 37.9% of such patients were receiving an antidepressant in 11 Argentine outpatient clinics. Antidepressant treatment was least likely with type I disorder and was independent of current depression and not associated with more use of mood-stabilizing or antimanic agents.
Antidepressants in the Treatment of Bipolar Disorder: Decoding Contradictory Evidence and Opinion
Harvard Review of Psychiatry, 2008
For many people with bipolar disorder, the goal of consistent mood stabilization is never achieved. Rates of relapse and inter-episode subsyndromal symptoms are high. 1−3 On average, patients in these studies were well only for about 50% of the time or less. Furthermore, bipolar disorder has not only an extreme level of morbidity, but also a very significant mortality rate due to suicide-estimated to be approximately 15%. 4−6 The role of antidepressants in the treatment of bipolar disorder poses critical, but controversial, questions. While it is generally accepted that mood stabilizers form the foundation for treating bipolar disorder, the effectiveness and safety of adjunctive antidepressant medications have not been definitively established. Research on this problem is extremely difficult to undertake, given the unstable nature of the illness and the requirement for multiple interventions over long periods of time. Reviews and meta-analyses from highly regarded academic centers have yielded contradictory findings and given rise to conflicting opinions. Concern about the negative impact of antidepressant medications-that they caused rapid cycling and switches from depression into mania-was initially raised by Wehr and Goodwin. 7 There continue to be questions about the propensities of antidepressants to cause cycle acceleration, switches into hypomania or mania, and mixed states. The
2015
The use of antidepressants in treatment of depression in course of bipolar disorders (BD) is controversial. In case of no improvement during monotherapy with mood stabilizer, the use of antidepressants is often necessary. The safety of this group (in context of phase change, mixed states and rapid cycling) is essential and is the subject of many research. In the paper, the authors review the literature concerning efficacy and safety of use of antidepressants in the treatment of affective disorders and long-term impact on the course of the disease. Selection of articles have been made by searching the Medline and Pubmed databases using keywords: antidepressant drugs, bipolar depression, bipolar disorder, efficacy, safety, mania, hypomania. The risk of mania is greater in bipolar disorder type I, than in type II or during treatment with Tricyclic antidepressants (TCAs) and treatment with venlafaxine. The use of SSRIs and bupropion is associated with a relatively small increase of phas...
Correspondence Sir, The use of anti-depressants in bipolar depression remains a controversial and emotive issue among mental health clinicians and practitioners. Despite the lack of a strong evidence base for treatment benefits with anti-depressants for bipolar depression, [1] the reality is that most of us continue to recommend these agents for our patients. There are a number of issues that seem to cloud our judgment in this matter. On the one hand, there is evidence about a subset of individuals with bipolar disorder who may derive definite benefit from being put on anti-depressants when they are experiencing symptoms of depression, and on the other hand there are enduring concerns about their 'mood-destabilizing properties' — short-term switching from depression to hypomania or mania, and paucity of evidence of their long-term efficacy in treating bipolar depression. [2] Obviously, there is a need to take a balanced stance that is true to evidence and also takes into acc...
Clinical characteristics of antidepressant use and related manic switch in bipolar disorder
Neurosciences
Objectives: To examine the association between clinical and treatment characteristics and antidepressants)AD(-induced manic switch in bipolar disorder)BD(. Methods: Total of 238 euthymic BD patients, who had been followed-up for at least 6 months at the outpatient clinic of Haseki Training and Research Hospital in istanbul, Turkey, were enrolled in this cross-sectional study in 2016. Semi-structured data form, the mood chart, and the mirror-designated assessment were applied to all subjects. The files of the patients were retrospectively reviewed and the patients using ADs were compared as AD-monotherapy)ADm(and AD-combination)AD-c(groups, then divided into 2 subgroups according to the presence/absence of manic switch under AD treatment. Results: Fifty eight)47.15%(patients out of 123 who received ADs at least once had experienced a manic switch under AD treatment. The rate of manic switch in AD-m patients was significantly higher than the AD-c group. Independent from being monotherapy or combined treatment, AD use longer than 12 months was negatively associated with the occurrence of manic switch. Conclusion: Our study suggests that the risk of manic switch is especially prominent in the first months of AD use. Antidepressants use in combining it with a mood stabilizers)MS(may not be adequate in preventing switches in shorter terms. However, in longer term uses addition of MS to ADs may decrease the risk of switches.