Antidepressant-induced mania and cycle acceleration: a controversy revisited

Altshuler, Lori L.; Post, Robert M.; Leverich, Gabriele S.; Mikalauskas, Kirstin; Rosoff, Ann S.; Ackerman, Laura

doi:10.1176/ajp.152.8.1130

Cited by 435 publications

(38 citation statements)

References 72 publications

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“…Whereas some studies have reported benefit from continuation antidepressant therapy in patients who have recovered from bipolar depression (Altshuler et al, 2009; Amsterdam et al, 1998; Amsterdam and Shults, 2010a, b; Kupfer et al, 2001), other studies have not confirmed this finding or have reported increased mood conversion rates during continuation antidepressant use (Altshuler et al, 1995; Ghaemi et al, 2004; Leverich et al, 2006; Sachs et al, 2007; Vieta, 2008; Viktorin et al, 2014). A retrospective chart review study by Altshuler et al (2001) examined the risk of depressive relapse over one year in recovered bipolar depressed subjects who either continued or discontinued antidepressant therapy.…”

Section: Discussionmentioning

confidence: 94%

“…Long-term antidepressant therapy for relapse-prevention of bipolar depression has received relatively little attention (Altshuler et al, 2003; Altshuler et al, 1995; Bond et al, 2008; Ghaemi et al, 2001; Ghaemi et al, 2004). Whereas some studies have reported benefit from continuation antidepressant therapy in patients who have recovered from bipolar depression (Altshuler et al, 2009; Amsterdam et al, 1998; Amsterdam and Shults, 2010a, b; Kupfer et al, 2001), other studies have not confirmed this finding or have reported increased mood conversion rates during continuation antidepressant use (Altshuler et al, 1995; Ghaemi et al, 2004; Leverich et al, 2006; Sachs et al, 2007; Vieta, 2008; Viktorin et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Studies of mixed populations of bipolar I and II depressed patients have reported increases in manic symptoms and depressive relapse during antidepressant prophylaxis (Altshuler et al, 1995; Ghaemi et al, 2004; Leverich et al, 2006; Sachs et al, 2007). For example, one controlled trial reported adequate antidepressant effectiveness, but more treatment-emergent manic symptoms during venlafaxine versus sertraline or bupropion therapy (Leverich et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

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Safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for relapse-prevention of bipolar II depression: A randomized, double-blind, parallel-group, prospective study

Amsterdam

Lorenzo‐Luaces

Soeller

et al. 2015

Journal of Affective Disorders

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Objective Compare the safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for preventing depressive relapse in bipolar II disorder. Methods Subjects ≥18 years old with bipolar II depression (n=129) were randomized to double-blind venlafaxine or lithium monotherapy for 12 weeks. Responders with a ≥50% reduction in depression score were continued for an additional 6 months of relapse-prevention monotherapy. Primary outcome was depressive relapse during continuation monotherapy. Secondary outcomes included sustained response rate from initiation of treatment to study end-point, relapse hazard, time to relapse, change in mania ratings, and frequency of treatment-emergent sub-syndromal hypomania and/or depressive episodes. Results Venlafaxine produced greater sustained response rate versus lithium (p<0.0001); however, there was no difference in relapse rate for venlafaxine (7.5%) versus lithium (26.7%) (p=0.079); relapse hazard (p=0.073), or time to relapse (p=0.090) between treatment conditions during continuation monotherapy. There were no group differences in mania rating scores over time and no difference in frequency or duration of syndromal or sub-syndromal hypomanic episodes. There were more sub-syndromal depressive episodes during lithium monotherapy (p=0.03). Limitations Sample size was limited by the lower sustained response rate for lithium versus venlafaxine; study was not specifically powered to detect differences in treatment-emergent hypomanic or depressive episodes between groups. Conclusion Results suggest that continuation venlafaxine monotherapy may provide similar prophylactic effectiveness relative to lithium, with no difference in treatment-emergent hypomanic episodes and without the need for frequent serum lithium level and metabolic monitoring. Larger, prospective trials are needed to confirm these observations.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for relapse-prevention of bipolar II depression: A randomized, double-blind, parallel-group, prospective study

Amsterdam

Lorenzo‐Luaces

Soeller

et al. 2015

Journal of Affective Disorders

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“…Anger attacks showed good response to antidepressants alone in MDD [11], and the rate of switch into mania or hypomania with monotherapy with antidepressants was comparable in MDD with and without anger attacks [14]. On the other hand, antidepressants alone can increase anger and mood instability in bipolar depression [2, 4, 6, 7, 8, 15, 16, 17, 18, 19, 20, 21, 22]. Given the apparent different impact of antidepressants on anger in MDD and in bipolar disorders, it is important for clinicians to know if MDD with anger is closer to bipolar disorders than to MDD.…”

Section: Introductionmentioning

confidence: 99%

Major Depressive Disorder with Anger: A Bipolar Spectrum Disorder?

Benazzi

2003

Psychother Psychosom

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Background: Depression with anger may be more common in bipolar disorders. The aim of the study was to assess whether major depressive disorder (MDD) with anger could be included in the bipolar spectrum, by comparing it to MDD without anger and to bipolar II disorder. Methods: Consecutive outpatients (281 bipolar II disorder and 202 MDD) presenting for major depressive episode (MDE) treatment were interviewed with the DSM-IV structured clinical interview. Clinical variables used to support the inclusion of MDD with anger in the bipolar spectrum were age of onset, many MDE recurrences, atypical features of depression, depressive mixed state (an MDE plus some concurrent hypomanic symptoms), and bipolar family history. Results: Frequency of MDE with anger was 50.5% [61.2% in bipolar II, and 35.6% in MDD (z = 5.5, p = 0.0000, 95% CI 16.8–43.3%)]. Logistic regression of MDE with anger (dependent variable) versus bipolar variables showed that MDE with anger was significantly associated with all bipolar variables, apart from recurrences. MDD with anger, compared with MDD without anger, had significantly lower age of onset, more marked depressive mixed state, a bipolar family history with more cases, but comparable atypical features and Global Assessment of Functioning scores. MDD with anger, compared with bipolar II disorder, had significantly higher age of onset, less atypical features, and a bipolar family history with less cases. Conclusions: MDE with anger was common in outpatients (more in bipolar II disorder). MDD with anger may be midway between MDD without anger and bipolar II disorder, and might be included into the bipolar spectrum. However, MDD with anger does not appear to be associated with the often reported negative response to monotherapy with antidepressants.

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“…However, it has been suggested that ADs may increase the risk of manic induction and cycle acceleration 9–11. Furthermore, both anxiety disorder comorbidity, which has a lifetime prevalence of 45% in individuals with BPs,12 and exposure to a greater number of AD trials have been suggested as independent predictors of prospective long-term nonresponse to treatment 13.…”

Section: Introductionmentioning

confidence: 99%

Long-term efficacy and safety of lamotrigine for all types of bipolar disorder

Watanabe¹,

Hongō²

2017

NDT

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BackgroundWe investigated whether the long-term efficacy and safety of lamotrigine (LTG) for bipolar disorder (BP) differs between disease types (BP-I, BP-II, or BP not otherwise specified [BP-NOS]), and the efficacy of the concomitant use of antidepressants (ADs).MethodsFor >1 year, we observed 445 outpatients with BP (diagnosed by DSM-IV criteria) who initiated LTG treatment between July 1 and October 31, 2011, using the Himorogi Self-rating Depression (HSDS) and Anxiety Scales and the Clinical Global Impression-Improvement scale and also recorded adverse events.ResultsTreatment efficacy was observed at week 4, with the improved HSDS scores sustained until week 52 for all types of BP; 50% of the patients with any type of BP could be treated with LTG for 1 year, whereas ~40% could be treated for >1.5 years. However, 25% of the patients were withdrawn within the first 4 weeks. The overall incidence of adverse events was 22.9% (104/455): 34.1% (14/41) for BP-I, 22.7% (15/66) for BP-II, and 22.2% (75/338) for BP-NOS. The most common adverse event was skin rash: 22.0% for BP-I, 16.7% for BP-II, and 12.1% for BP-NOS.LimitationsThere was no control group. Data were collected retrospectively.ConclusionWith careful and adequate titration, long-term treatment with LTG is possible for any type of BP, with BP-NOS patients, the largest population in clinical practice, responding particularly well. Symptoms can improve with or without ADs. Large-scale prospective studies of the efficacy of ADs in bipolar treatment are warranted.

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Antidepressant-induced mania and cycle acceleration: a controversy revisited

Cited by 435 publications

References 72 publications

Safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for relapse-prevention of bipolar II depression: A randomized, double-blind, parallel-group, prospective study

Safety and effectiveness of continuation antidepressant versus mood stabilizer monotherapy for relapse-prevention of bipolar II depression: A randomized, double-blind, parallel-group, prospective study

Major Depressive Disorder with Anger: A Bipolar Spectrum Disorder?

Long-term efficacy and safety of lamotrigine for all types of bipolar disorder

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