Incidence, prevalence and clinical correlates of antidepressant‐emergent mania in bipolar depression: a systematic review and meta‐analysis

Fornaro, Michele; Anastasia, Annalisa; Novello, Stefano; Fusco, Andrea; Solmi, Marco; Monaco, Francesco; Veronese, Nicola; Berardis, Domenico De; Bartolomeis, Andrea de

doi:10.1111/bdi.12612

Cited by 63 publications

(27 citation statements)

References 89 publications

(103 reference statements)

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“…Equally importantly is how, even after functional improvement and so‐called recovery, individuals remain vulnerable to further relapses/recurrences. From research efforts to date, it is known that life events play a significant role in precipitating recurrence56 and that even medications can trigger both “highs” and “lows.”57‐59 Furthermore, in some individuals, there is a periodicity (or seasonality) to recurrence that sometimes seems impervious to treatment. Understanding these more complex aspects of mood disorders clearly requires a longer term and more sophisticated perspective that can be provided by longitudinal studies and the adoption of a model that is not predicated on current diagnostic thinking.…”

Section: The Ace Modelmentioning

confidence: 99%

Modelling mood disorders: An ACE solution?

et al. 2018

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Objectives The treatment of mood disorders remains sub‐optimal. A major reason for this is our lack of understanding of the underlying pathophysiology of depression and bipolar disorder. A core problem is the lack of specificity of our current diagnoses. This paper discusses the history of this problem and posits a solution in the form of a more sophisticated model. Method The authors review the notable historical works that laid the foundations of mood disorder nosology; discuss the more recent influences that shaped modern diagnoses; and examine the evidence that mood disorders are characterised by multidimensional and longitudinal symptom profiles. Results The ACE model considers mood disorders as a combination of symptoms across three domains: Activity, Cognition, and Emotion; that vary over time. This multidimensional and longitudinal perspective is consistent with the prevalence of complex clinical presentations, such as mixed states, and highlights the importance of recurrence in mood disorders. Conclusions The ACE model encourages researchers to characterise patients from a number of equally important perspectives and, by doing so, add specificity to the treatment of mood disorders.

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Section: The Ace Modelmentioning

confidence: 99%

Modelling mood disorders: An ACE solution?

et al. 2018

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“…Our study indicates that a substantial proportion of BD patients (44.7%) were initially misdiagnosed with MDD. This finding can explain why AD monotherapy was the most commonly used treatment regimen and is of particular interest given the concerns about AD‐induced risk of manic switch, and potential contribution of the latter to treatment non‐adherence. This highlights the challenges of the proper identification of BD in routine care settings and the negative sequelae of an incorrect diagnosis, given the significantly elevated risk for psychiatric hospitalization associated with this prescribing pattern.…”

Section: Discussionmentioning

confidence: 94%

“…30 The findings on the reduced risk of psychiatric hospitalizations for patients on antibiotics and non-steroidal anti-inflammatory drugs contribute to the evidence suggesting the importance of immune alterations, inflammation, and the microbiome in BDs. 34 It is important to consider some additional limitations of the study, This finding can explain why AD monotherapy was the most commonly used treatment regimen and is of particular interest given the concerns about AD-induced risk of manic switch, 35 and potential contribution of the latter to treatment non-adherence. This highlights the challenges of the proper identification of BD in routine care settings and the negative sequelae of an incorrect diagnosis,…”

Section: × 10 −12mentioning

confidence: 99%

Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders

Nestsiarovich

Mazurie²,

Hurwitz³

et al. 2018

Bipolar Disorders

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This largest reported retrospective observational study on bipolar disorders pharmacotherapy to date demonstrates that the majority of patients end monotherapy within 2 months after treatment start. The risk of psychiatric hospitalization varied almost two-fold across individual medications. The data add to the evidence favoring lithium and mood stabilizer use in short-term bipolar disorder management. The findings that the dopaminergic drugs aripiprazole and bupropion had better outcomes than other members of their respective classes and that antidepressant outcomes may vary by baseline mood polarity merit further investigation.

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“…In the absence of approved treatments for mixed features, antidepressants are commonly used to treat mixed symptoms, but they are generally ineffective and may raise the risk of manic episodes in this population. 18,19 In addition, as bipolar depression is frequently misdiagnosed as unipolar depression 20 , antidepressants may also be incorrectly prescribed, which can lead to reduced treatment response. There is evidence that atypical antipsychotics, which can lower the severity of both depressive and manic symptoms, may be able to treat bipolar depression with mixed symptoms.…”

Section: Introductionmentioning

confidence: 99%

Cariprazine efficacy in bipolar I depression with and without concurrent manic symptoms: post hoc analysis of 3 randomized, placebo-controlled studies

et al. 2019

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Objective. Mixed presentations, defined by simultaneous occurrence of depressive and manic symptoms, are difficult to treat. Antidepressants, although commonly used, have weak evidence of efficacy and may increase risk of mood destabilization. The aim of this pooled post hoc analysis was to evaluate the efficacy of cariprazine in the treatment of bipolar depression with or without concurrent manic symptoms. Methods. Patients from 3 randomized, double-blind, placebo-controlled studies who met DSM-IV-TR or DSM-5 criteria for bipolar I disorder with a current major depressive episode were identified to have concurrent manic symptoms by baseline Young Mania Rating Scale total score ≥4. Efficacy was assessed in cariprazine 1.5 and 3 mg/day dose groups versus placebo; analyses included the least squares mean change from baseline to week 6 in Montgomery-Åsberg Depression Rating Scale (MADRS) total score. Results. Of 1383 patients randomized to treatment, 808 (58.4%) had concurrent manic symptoms. For patients with manic symptoms, mean reduction in MADRS total score from baseline to week 6 was significantly greater for both cariprazine 1.5 and 3 mg/day compared with placebo, with least squares mean differences (LSMDs) versus placebo of −2.5 (p = .0033) and −2.9 (p = .0010), respectively; for patients without manic symptoms, the LSMD was significant for 1.5 mg/day (−3.3; p = .0008), but not for 3 mg/day (−1.9; p = .0562). Conclusion. The results of this post hoc analysis suggest that cariprazine may be an appropriate treatment option for patients with bipolar I depression with or without manic symptoms, with higher doses potentially more effective in patients with manic symptoms.

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Incidence, prevalence and clinical correlates of antidepressant‐emergent mania in bipolar depression: a systematic review and meta‐analysis

Cited by 63 publications

References 89 publications

Modelling mood disorders: An ACE solution?

Modelling mood disorders: An ACE solution?

Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders

Cariprazine efficacy in bipolar I depression with and without concurrent manic symptoms: post hoc analysis of 3 randomized, placebo-controlled studies

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