Manic Symptoms During Depressive Episodes in 1,380 Patients With Bipolar Disorder: Findings From the STEP-BD

Goldberg, Joseph F.; Perlis, Roy H.; Bowden, Charles L.; Thase, Michael E.; Miklowitz, David J.; Marangell, Lauren B.; Calabrese, Joseph R.; Nierenberg, Andrew A.; Sachs, Gary S.

doi:10.1176/appi.ajp.2008.08050746

Cited by 254 publications

(211 citation statements)

References 38 publications

(38 reference statements)

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“…Goldberg et al reported that chance of antidepressants causing manic switch is not different from placebo even in patients with history of manic switch or ST manic symptoms (30,31). In our sample, although there is a history of manic switch while using antidepressants, manic shwitch frequency was found only 6.4% during antidepressant use.…”

Section: Discussioncontrasting

confidence: 59%

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

Atagün¹,

Altınbaş²,

Yeşilyurt³

et al. 2012

Dusunen Adam

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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...

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Section: Discussioncontrasting

confidence: 59%

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

Atagün¹,

Altınbaş²,

Yeşilyurt³

et al. 2012

Dusunen Adam

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“…Many patients with bipolar depression will also experience at least subsyndromal hypomanic or manic features, and this presentation is associated with more severe depressive symptoms, as well as a higher rate of substance use and cardiovascular disease 317. For many of these patients, combination therapy will be necessary to adequately address symptoms 318.…”

Section: Acute Management Of Bipolar Depressionmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…Overall, this definition of hypomanic symptoms, which includes severity, impairment and duration criteria, is more conservative than several other studies, which have tended to use only the threshold score of 14 (Hardoy et al 2005;Meyer et al 2007Meyer et al , 2014. We chose a duration criterion of 2-3 days or more because the 4-day threshold within the Diagnostic and Statistical Manual of Mental Disorders (DSM) excludes many individuals with bipolar disorder type II (Goldberg et al 2009;Bauer et al 2011;Parker et al 2014), and because 2 days is known to be the modal duration of hypomania in bipolar II disorder (Benazzi, 2001;Angst & Cassano, 2005). Based on previous work in non-clinical samples, we expected 5-10% of respondents to satisfy our criteria for features of hypomania (Meyer et al 2007;Holtmann et al 2009).…”

Section: Assessment Of Hypomanic Symptomsmentioning

confidence: 99%

Childhood interleukin-6, C-reactive protein and atopic disorders as risk factors for hypomanic symptoms in young adulthood: a longitudinal birth cohort study

Hayes¹,

Khandaker²,

Anderson³

et al. 2017

Psychol. Med.

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Background. There are no existing longitudinal studies of inflammatory markers and atopic disorders in childhood and risk of hypomanic symptoms in adulthood. This study examined if childhood: (1) serum interleukin-6 (IL-6) and C-reactive protein (CRP); and (2) asthma and/or eczema are associated with features of hypomania in young adulthood.Method. Participants in the Avon Longitudinal Study of Parents and Children, a prospective general population UK birth cohort, had non-fasting blood samples for IL-6 and CRP measurement at the age of 9 years (n = 4645), and parents answered a question about doctor-diagnosed atopic illness before the age of 10 years (n = 7809). These participants completed the Hypomania Checklist at age 22 years (n = 3361).Results. After adjusting for age, sex, ethnicity, socio-economic status, past psychological and behavioural problems, body mass index and maternal postnatal depression, participants in the top third of IL-6 values at 9 years, compared with the bottom third, had an increased risk of hypomanic symptoms by age 22 years [adjusted odds ratio 1.77, 95% confidence interval (CI) 1.10-2.85, p < 0.001]. Higher IL-6 levels in childhood were associated with adult hypomania features in a dose-response fashion. After further adjustment for depression at the age of 18 years this association remained (adjusted odds ratio 1.70, 95% CI 1.03-2.81, p = 0.038). There was no evidence of an association of hypomanic symptoms with CRP levels, asthma or eczema in childhood.Conclusions. Higher levels of systemic inflammatory marker IL-6 in childhood were associated with hypomanic symptoms in young adulthood, suggesting that inflammation may play a role in the pathophysiology of mania. Inflammatory pathways may be suitable targets for the prevention and intervention for bipolar disorder.

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Manic Symptoms During Depressive Episodes in 1,380 Patients With Bipolar Disorder: Findings From the STEP-BD

Cited by 254 publications

References 38 publications

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

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

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Childhood interleukin-6, C-reactive protein and atopic disorders as risk factors for hypomanic symptoms in young adulthood: a longitudinal birth cohort study

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