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

Abstract

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...