Antidepressant-induced hypomania/mania in patients with major depression: Evidence from the BRIDGE-II-MIX study

Barbuti, Margherita; Pacchiarotti, Isabella; Vieta, Eduard; Azorin, J.-M.; Angst, Jules; Bowden, Charles L.; Sn, Mosolov; Young, Allan H.; Perugi, Giulio

doi:10.1016/j.jad.2017.05.035

Cited by 51 publications

(42 citation statements)

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“…A recent post-hoc analysis of the BRIDGE-II-mix study showed that comorbidities with eating disorders and anxiety disorders were more frequently associated with a BD diagnosis. 50 In this sense, a possible association between obesity, eating disorders, and bipolar spectrum disorders could be hypothesized, in line with previous findings. 49 This comorbidity has been associated with an increased severity of eating behaviors, poorer prognosis for obesity, and treatment resistance in BD.…”

Section: Discussionsupporting

confidence: 81%

“…With regard to lifetime comorbid diagnosis, in accordance with the existing literature, we found that comorbidity with eating disorders and anxiety disorders was more frequently reported in MDE‐OB patients than in MDE‐NOB subjects. A recent post‐hoc analysis of the BRIDGE‐II‐mix study showed that comorbidities with eating disorders and anxiety disorders were more frequently associated with a BD diagnosis . In this sense, a possible association between obesity, eating disorders, and bipolar spectrum disorders could be hypothesized, in line with previous findings .…”

Section: Discussionsupporting

confidence: 68%

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Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

et al. 2017

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Objectives: BRIDGE-II-MIX study aimed to estimate the frequency of mixed states in patients with MDE according to different definitions. This post-hoc analysis evaluates the association between obesity and the presence of mixed features and bipolarity. Methods: 2811 MDE subjects were enrolled in this multicentre crosssectional study. In 2744 patients, the body mass index (BMI) has been evaluated.Psychiatric symptoms, socio-demographic and clinical variables were collected, comparing the characteristics of MDE patients with (MDE-OB) and without obesity (MDE-NOB). Results: obesity (BMI ≥30) was registered in 493 patients (18%). In the MDE-OB group, 90 patients (20%) fulfilled DSM-IV-TR criteria for BD, 225 patients (50%) fulfilled the criteria for bipolarity specifier, 59 patients (13%) fulfilled DSM-5 criteria for MDE with mixed features and 226 patients (50%) fulfilled Research-Based Diagnostic Criteria for a mixed depressive episode. Older age, history of (hypo)manic switches during antidepressant treatment, the occurrence of three or more MDEs, atypical depressive features, antipsychotic treatment, female gender, depressive mixed state according to DSM-5 criteria, comorbid eating disorders and anxiety disorders were significantly associated with MDE-OB group. Among (hypo)manic symptoms during the current MDE, psychomotor agitation, distractibility, increased energy and risky behaviors were the variables most frequently associated with MDE-OB group.Conclusions: In our sample, the presence of obesity in patients with MDE seems to be associated with a lifetime diagnosis of BD. These findings suggest that obesity in patients with MDE could be considered a possible marker of bipolarity.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 68%

Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

et al. 2017

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“…Furthermore, previous studies have reported that subthreshold manic/hypomanic symptoms are frequently associated with subsequent progression to BD in patients with MDD diagnoses. Associations have also been observed for antidepressant-induced mania/hypomania and a family history of BD, suggesting that mixed monopolar major depression belongs to the bipolar spectrum [15,20,21].…”

Section: Impact On Mood Disordersmentioning

confidence: 95%

“…In this way, mixed depression does not necessarily reflect an admixture of manic/hypomanic and depressive symptoms, but rather represents a bridge between bipolar and monopolar illnesses. Mixed depression is common in clinical settings, accounting for 48.9% (median, range: 22.9-72.3%, nine studies [7,[9][10][11][12][13][14][15][16] ing/crowded thoughts experience thoughts at an abnormal speed or an increase in the amount of thoughts. Racing thoughts are those that occur in rapid succession or continuously overlap, without any link between them [17].…”

Section: Prevalence Symptomatology and Diagnostic Issuesmentioning

confidence: 99%

“…However, some researchers have expressed concerns regarding this stipulation because overlapping symptoms are common and have even been emphasized as the core symptoms of mixed depression, as described elsewhere [10]. Several studies have noted that the prevalence of mixed depression is only 7.4% in patients with BD (median, range 6.3-17.5%, four studies [10][11][12]15]) and 5.6% in patients with MDD (median, range 0-15.5%, three studies [10,15,22]) when these criteria are adopted. Furthermore, more inclusive definitions of mixed depression (i.e., an MDE with !3 non-overlapping or overlapping manic/hypomanic symptoms) have yielded statistically more robust associations with several illness-related characteristics of BD than DSM-5 criteria [8].…”

Section: Dsm-5 Definition Including the Mixed Features Specifiermentioning

confidence: 99%

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Early recognition and appropriate pharmacotherapy for mixed depression: the key to resolving complex or treatment-refractory clinical cases

Takeshima

2019

CNPT

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Mixed depression refers to the co-existence of a major depressive episode (MDE) and sub-threshold manic/ hypomanic symptoms. Mixed depression is a common clinical entity, occurring in approximately 50% and 30% of MDEs due to bipolar disorder (BD) and major depressive disorder (MDD), respectively. However, it remains underdiagnosed and very often misdiagnosed as simply major depression, adjustment disorder, anxiety disorder, or borderline personality disorder. Mixed depression suggests a diagnosis of BD in patients experiencing an MDE, and is associated with future progression to BD, antidepressant-induced mania/hypomania, and a family history of BD in patients with MDD. Patients with mixed depression exhibit poor prognosis, experiencing more severe episodes of longer duration, less inter-episodic remission, higher recurrence rates, more rapid cycling, a higher rate of co-morbid substance use and anxiety disorders, and a higher risk of suicidality. Antidepressant use can exacerbate symptoms of agitation and irritability and induce newlydeveloped suicidality without improving depressive symptoms. Because treatment strategies differ for mixed and non-mixed states, it is important to screen all patients with depression for co-existing manic/hypomanic symptoms. In this report, the author briefly reviews the clinical presentation, diagnosis, and impact of mixed depression on the course of mood disorders and pharmacological treatment.

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Vortioxetine as a potential alternative for patients with escitalopram‐induced jitteriness/anxiety syndrome: A report of three cases

Arai,

Nonaka,

Shimada

et al. 2023

PCN Reports

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BackgroundJitteriness/anxiety syndrome is a recognized adverse effect observed during the initiation or change of dose in antidepressant treatment. Managing patients who develop this syndrome remains a challenge. While escitalopram is a widely used antidepressant known to cause these symptoms, this report explores vortioxetine as a therapeutic alternative.Case PresentationThree distinct clinical scenarios were observed in patients who manifested jitteriness/anxiety syndrome while on escitalopram treatment for depression. Patient A was initiated on escitalopram and experienced an initial alleviation in depressive symptoms, but 3 months later displayed mood elevation, talkativeness, and increased activity, which disturbed his daily life. A transition to vortioxetine subsequently resolved the mood elevation. Patient B exhibited elevated mood, hyperactivity, irritability, and talkativeness just 6 days post‐initiation of treatment with escitalopram. After the discontinuation of escitalopram and unsuccessful trials with aripiprazole, lurasidone, and lamotrigine, her depressive mood intensified, culminating in suicidal ideation. Starting vortioxetine led to a consistent improvement of her symptoms, and she resumed work and was emotionally stable. Patient C was initially diagnosed with bipolar disorder and faced a relapse into depression despite undergoing various treatments. After 2 weeks on escitalopram, she exhibited irritability and self‐harm urges. Three months later, after being re‐diagnosed with depressive disorders with anxious distress, vortioxetine was administered, which significantly reduced her depressive symptoms and allowed her to continue her education.ConclusionVortioxetine presents as a promising therapeutic alternative that is worth considering for patients with escitalopram‐induced jitteriness/anxiety syndrome.

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Antidepressant-induced hypomania/mania in patients with major depression: Evidence from the BRIDGE-II-MIX study

Cited by 51 publications

References 40 publications

Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

Early recognition and appropriate pharmacotherapy for mixed depression: the key to resolving complex or treatment-refractory clinical cases

Vortioxetine as a potential alternative for patients with escitalopram‐induced jitteriness/anxiety syndrome: A report of three cases

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