Risk of Switch in Mood Polarity to Hypomania or Mania in Patients With Bipolar Depression During Acute and Continuation Trials of Venlafaxine, Sertraline, and Bupropion as Adjuncts to Mood Stabilizers

Leverich, Gabriele S.; Altshuler, Lori L.; Frye, Mark A.; Suppes, Trisha; McElroy, Susan L.; Keck, Paul E.; Kupka, Ralph; Denicoff, Kirk D.; Nolen, Willem A.; Grunze, Heinz; Martínez, M.; Post, Robert M.

doi:10.1176/appi.ajp.163.2.232

Cited by 347 publications

(243 citation statements)

References 28 publications

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“…This incidence is broadly similar to that observed in other longitudinal studies such as the Stanley Foundation cohort (Frye et al, 2009;Leverich et al, 2006) when that study examined postacute treatment outcomes. Not surprisingly, rates were about twice than those observed in randomized, placebocontrolled studies (Keck et al, 2005;Nemeroff et al, 2001;Sachs et al, 2007), which considered only short-term transition to mania.…”

Section: Discussionsupporting

confidence: 85%

“…Older studies examining antidepressanttreated patients with bipolar disorder, which included subjects not treated with mood-stabilizing medication, suggested that a transition directly to mania was observed in up to 50% of the cases (for a synopsis see Calabrese et al, 1999). For second-generation antidepressants combined with mood stabilizers, a more recent large study suggested switch rates of 12-22% during acute treatment, depending on the definition of mania used Leverich et al, 2006). In contrast, multiple recent randomized placebo-controlled trials indicate that the risk of transition during an acute treatment trial is less than 10% when antidepressants are combined with mood stabilizersFrates that are comparable to or lower than those found in placebo control conditions (Keck et al, 2005;Nemeroff et al, 2001;Sachs et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

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Transition to Mania During Treatment of Bipolar Depression

Perlis

Ostacher

Goldberg

et al. 2010

Neuropsychopharmacol

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Some individuals with bipolar disorder transition directly from major depressive episodes to manic, hypomanic, or mixed states during treatment, even in the absence of antidepressant treatment. Prevalence and risk factors associated with such transitions in clinical populations are not well established, and were examined in the Systematic Treatment Enhancement Program for Bipolar Disorder study, a longitudinal cohort study. Survival analysis was used to examine time to transition to mania, hypomania, or mixed state among 2166 bipolar I and II individuals in a major depressive episode. Cox regression was used to examine baseline clinical and sociodemographic features associated with hazard for such a direct transition. These features were also examined for interactive effects with antidepressant treatment. In total, 461/2166 subjects in a major depressive episode (21.3%) transitioned to a manic/hypomanic or mixed state before remission, including 289/1475 (19.6%) of those treated with antidepressants during the episode. Among the clinical features associated with greatest transition hazard were greater number of past depressive episodes, recent or lifetime rapid cycling, alcohol use disorder, previous suicide attempt, and history of switch while treated with antidepressants. Greater manic symptom severity was also associated with risk for manic transition among both antidepressant-treated and antidepressant-untreated individuals. Three features, history of suicide attempt, younger onset age, and bipolar subtype, exhibited differential effects between individuals treated with antidepressants and those who were not. These results indicate that certain clinical features may be associated with greater risk of transition from depression to manic or mixed states, but the majority of them are not specific to antidepressant-treated patients.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Transition to Mania During Treatment of Bipolar Depression

Perlis

Ostacher

Goldberg

et al. 2010

Neuropsychopharmacol

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“…15 Also, bupropion, an antidepressant which increases synaptic dopamine and noradrenaline levels, is less prone to induce manic switches than sertraline and venlafaxine, antidepressants with smaller effect on dopaminergic neurotransmission. 16 In PD, decreased dopaminergic levels may affect the frequency of manic and depressive episodes. Nevertheless, dopamine replacement therapy is not always able to treat non-motor symptoms of PD, and these patients respond to antidepressants with serotonergic mechanism of action.…”

Section: Discussionmentioning

confidence: 99%

Low frequency of bipolar disorder, dopamine dysregulation syndrome, and punding in Brazilian patients with Parkinson's disease

Kümmer

Dias

Cardoso

et al. 2010

Rev. Bras. Psiquiatr.

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“…There are contradictory results with consequences of antidepressant treatment. There are studies showing that antidepressants are either effective (23,27) or may cause manic switches (11,28). However, there are studies reporting that antidepressants are ineffective and do not cause manic switches (3,7,29).…”

Section: Discussionmentioning

confidence: 99%

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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Risk of Switch in Mood Polarity to Hypomania or Mania in Patients With Bipolar Depression During Acute and Continuation Trials of Venlafaxine, Sertraline, and Bupropion as Adjuncts to Mood Stabilizers

Cited by 347 publications

References 28 publications

Transition to Mania During Treatment of Bipolar Depression

Transition to Mania During Treatment of Bipolar Depression

Low frequency of bipolar disorder, dopamine dysregulation syndrome, and punding in Brazilian patients with Parkinson's disease

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

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