Adjunctive Antidepressant Use and Symptomatic Recovery Among Bipolar Depressed Patients With Concomitant Manic Symptoms: Findings From the STEP-BD

Goldberg, Joseph F.; Perlis, Roy H.; Ghaemi, Mehran; Calabrese, Joseph R.; Bowden, Charles L.; Wisniewski, Stephen R.; Miklowitz, David J.; Sachs, Gary S.; Thase, Michael E.

doi:10.1176/appi.ajp.2007.05122032

Cited by 181 publications

(123 citation statements)

References 36 publications

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“…A secondary analysis of randomized data from the Stanley Foundation cohort (n ¼ 176) found that the greater the number of manic symptoms manifest during a depressive episode, the more likely a bipolar patient is to become syndromally manic/ hypomanic or mixed following antidepressant treatment (Frye et al, 2009), broadly consistent with a previous investigation (Goldberg et al, 2007). The Stanley Foundation study, however, did not examine a comparison group of subjects not treated with antidepressants, so the treatment specificity of risk could not be determined.…”

Section: Introductionsupporting

confidence: 78%

“…Risk factors for transition to mania included greater total YMRS at study entry, with greatest risk associated with motor activation, pressured speech, and racing thoughts (Frye et al, 2009). In a similar vein, we had previously reported a subset of 445 STEP-BD subjects with bipolar I, II, or NOS, where an interaction was noted between number of threshold or subthreshold manic symptoms, and antidepressant cotreatment in YMRS mania severity at 3 months (Goldberg et al, 2007). However, the interaction noted there was far from straightforward: subjects with 3 + manic symptoms at entry who received antidepressants actually had numerically lower YMRS scores at 3 months, whereas those with 0 manic symptoms who received antidepressants had numerically greater scores; moreover, differences in transition to mania were not examined.…”

Section: Discussionmentioning

confidence: 52%

“…In summary, our results suggest that transition directly to mania during major depressive episodes in bipolar disorder is common and associated with defined risk factors beyond subthreshold manic/mixed symptoms and substance use disorders (Frye et al, 2009;Goldberg et al, 2007). The majority of these appear to be treatment nonspecific, however, rather than tied to antidepressant treatment per se.…”

Section: Discussionmentioning

confidence: 72%

“…We also sought to extend previous reports of association between manic symptom severity and risk for transition to mania (Frye et al, 2009), or greater manic symptomatology (Goldberg et al, 2007). In a recent report, Frye and colleagues examined outcomes among 176 antidepressanttreated depressed bipolar patients randomized to one of three antidepressants.…”

Section: Discussionmentioning

confidence: 99%

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Transition to Mania During Treatment of Bipolar Depression

Perlis

Ostacher

Goldberg

et al. 2010

Neuropsychopharmacol

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Some individuals with bipolar disorder transition directly from major depressive episodes to manic, hypomanic, or mixed states during treatment, even in the absence of antidepressant treatment. Prevalence and risk factors associated with such transitions in clinical populations are not well established, and were examined in the Systematic Treatment Enhancement Program for Bipolar Disorder study, a longitudinal cohort study. Survival analysis was used to examine time to transition to mania, hypomania, or mixed state among 2166 bipolar I and II individuals in a major depressive episode. Cox regression was used to examine baseline clinical and sociodemographic features associated with hazard for such a direct transition. These features were also examined for interactive effects with antidepressant treatment. In total, 461/2166 subjects in a major depressive episode (21.3%) transitioned to a manic/hypomanic or mixed state before remission, including 289/1475 (19.6%) of those treated with antidepressants during the episode. Among the clinical features associated with greatest transition hazard were greater number of past depressive episodes, recent or lifetime rapid cycling, alcohol use disorder, previous suicide attempt, and history of switch while treated with antidepressants. Greater manic symptom severity was also associated with risk for manic transition among both antidepressant-treated and antidepressant-untreated individuals. Three features, history of suicide attempt, younger onset age, and bipolar subtype, exhibited differential effects between individuals treated with antidepressants and those who were not. These results indicate that certain clinical features may be associated with greater risk of transition from depression to manic or mixed states, but the majority of them are not specific to antidepressant-treated patients.

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Section: Introductionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Transition to Mania During Treatment of Bipolar Depression

Perlis

Ostacher

Goldberg

et al. 2010

Neuropsychopharmacol

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“…Goldberg et al reported that chance of antidepressants causing manic switch is not different from placebo even in patients with history of manic switch or ST manic symptoms (30,31). In our sample, although there is a history of manic switch while using antidepressants, manic shwitch frequency was found only 6.4% during antidepressant use.…”

Section: Discussioncontrasting

confidence: 60%

Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bipolar disorder / İki uçlu bozukluğu olan hastalarda depresif belirtilerin tedavisinde antidepresan tercihlerinin değerlendirilmesi

Atagün¹,

Altınbaş²,

Yeşilyurt³

et al. 2012

Dusunen Adam

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Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bipolar disorderObjective: Antidepressants are thought to cause manic switches and accelerate cycling in the treatment of bipolar depression. On the other hand, other evidence suggests that antidepressant neither cause manic switches, nor are effective for the treatment of bipolar depression. This study aimed to assess clinicians' attitudes towards antidepressant choices for treatment of bipolar depressive episodes and subthreshold depression. Methods: Medical records of 784 patients with bipolar disorder were investigated retrospectively. Antidepressants were used in 55 of 263 depressive episodes (20.9%). Data regarding 78 episodes (23 subthreshold symptoms, 55 episodes) of 68 patients (54 female, 14 male; mean age: 39.64±10.99) were obtained. Descriptive statistics were the evaluation method. Results: In our department, antidepressants were used in 20.9% of the patients in the treatment of bipolar depression. One third of patients receiving antidepressant prescriptions had a history of manic switch, 5 (21.7%) of the patients with subthreshold symptoms receiving antidepressant prescriptions had a history of manic switch. However, manic switch occurred in only 5 (6.4%) patients. Selective serotonin reuptake inhibitors were the most common cause (58.3%) of the manic switch in patients with a history of manic switch. Discussion: Clinicians are still using antidepressants in the treatment of bipolar depression. Antidepressants targeting many neurotransmitter systems can be used in the first line treatments and antidepressants can be used even in patients with a history of manic switch. This controversial topic should be studied prospectively with larger samples and it must be clarified whether this phenomenon is a natural course of the disorder or triggered by antidepressant medications. Key words: Bipolar depression, antidepressants, manic switch ÖZET İki uçlu bozukluğu olan hastalarda depresif belirtilerin tedavisinde antidepresan tercihlerinin değerlendirilmesiAmaç: Antidepresanların iki uçlu depresyonda manik kaymalara ve döngü hızlanmasına neden olabilecekleri düşünülmektedir. Diğer taraftan, antidepresanların manik kaymaya neden olmadıklarını, ama etkili de olmadıklarını gösteren araştırmalar bulunmaktadır. Bu araştırmada, uygulamada, klinisyenlerin iki uçlu depresyon tedavisinde antidepresan tercihlerinin ve antidepresan kullanımının sonuçlarının incelenmesi amaçlanmıştır. Yöntem: İki uçlu bozukluk tanısıyla izlenmekte olan 784 hastanın klinik kayıtları, geriye dönük incelendi. 263 depresif dönemin 55'inde (%20.9) antidepresan başlandığı belirlendi. Eşik altı (EA) ve eşik üstü (EÜ) depresif belirtilerin tedavisinde antidepresan eklenen 68 hastaya ait (54 kadın, 14 erkek; ortalama yaş: 39.64±10.99), 78 depresif döneme (23 EA, 55 depresif dönem) ilişkin bulgular kaydedildi. Veriler tanımlayıcı istatistik yöntemlerle değerlendirildi. Bulgular: Merkezimizde depresif dönemleri olan hastalara antidepresan başlam...

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N- methyl-D-aspartate Glutamate Receptor Antagonists and the Promise of Rapid-Acting Antidepressants

Krystal¹

2010

Arch Gen Psychiatry

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Adjunctive Antidepressant Use and Symptomatic Recovery Among Bipolar Depressed Patients With Concomitant Manic Symptoms: Findings From the STEP-BD

Cited by 181 publications

References 36 publications

Transition to Mania During Treatment of Bipolar Depression

Transition to Mania During Treatment of Bipolar Depression

Evaluation of antidepressant choices for the treatment of depressive symptoms in patients with bipolar disorder / İki uçlu bozukluğu olan hastalarda depresif belirtilerin tedavisinde antidepresan tercihlerinin değerlendirilmesi

N- methyl-D-aspartate Glutamate Receptor Antagonists and the Promise of Rapid-Acting Antidepressants

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