Antidepressant treatment-emergent affective switch in bipolar disorder: a prospective case-control study of outcome

Abstract

Antidepressant treatment-emergent affective switch in bipolar disorder: a prospective case-control study of outcome Ciclagem afetiva associada a tratamento com antidepressivo no transtorno bipolar: estudo caso-controle prospectivo A b s t r a c t Objective: Treatment-emergent affective switch has been associated to cycle acceleration and poorer outcome, but there are few studies addressing this issue. The aim of this study was to prospectively compare the outcome of patients presenting treatment-emergent affective switch with patients with spontaneous mania, regarding presence and polarity of a new episode and time to relapse. Method: Twenty-four patients with bipolar disorder according to the DSM-IV were followed for 12 months. Twelve patients had treatment-emergent affective switch and twelve had spontaneous mania. Patients were evaluated weekly with the Young Mania Rating Scale and the Hamilton Depression Scale until remission of the index episode, and monthly until completion of the 12-month follow-up. Results: Eleven patients with treatment-emergent affective switch had a recurrence on follow-up, all of them with major depressive episodes. In the group with spontaneous mania, six patients had a recurrence: two had a depressive episode, and four had a manic episode (p = 0.069 for new episode, p = 0.006 for polarity of the episode). Patients with treatment-emergent affective switch relapsed in a shorter period than patients with spontaneous mania (p = 0.016). Conclusions: In this first prospective study, treatment-emergent affective switch patients were at greater risk of relapses, especially depressive episodes, and presented a shorter duration of remission when compared with patients with spontaneous mania. Descriptors: Bipolar disorder; Clinical protocol; Antidepressive agents; Treatment outcome; Affective symptomsResumo Objetivo: A ciclagem para mania associada ao antidepressivo tem sido relacionada à aceleração do ciclo e pior evolução, mas há poucos estudos na literatura sobre este assunto. O objetivo deste estudo foi comparar prospectivamente a evolução de pacientes com mania associada a antidepressivo com pacientes com mania espontânea, em relação a tempo para recaída e polaridade do novo episódio. Método: Vinte e quatro pacientes com transtorno bipolar, de acordo com os critérios diagnósticos do DSM-IV, foram seguidos por 12 meses: 12 pacientes com mania associada a antidepressivo e 12 pacientes com mania espontânea. Os pacientes foram avaliados semanalmente com a Escala para Mania de Young e a Escala para Depressão de Hamilton até remissão do episódio inicial e, mensalmente, até completar o período de seguimento de 12 meses. Resultados: Onze pacientes com mania associada ao antidepressivo tiveram uma recorrência no seguimento, sendo todos os episódios depressivos. No grupo de mania espontânea, seis pacientes apresentaram recorrência, sendo dois episódios depressivos, e quatro episódios de mania (p = 0,069 para novo episódio e p = 0,006 para polaridade do episódio). Pacientes com mania associada a an...

Comment on "antidepressant treatment-emergent switch in bipolar disorder: a prospective case-control study of outcome"

“…2 Most of the previous studies to date have focused on the switch rates during the treatment of depressed bipolar patients, comparing those who switched with those who did not. 1, 3 The paper in this issue differs form others in that it includes a comparison with spontaneous mania, and thus providing important insights into the course of the disorder after an antidepressant induced manic switch.…”