Switch from Depression to Mania – A Record Study over Decades between 1920 and 1982

Abstract

A representative sample of 908 hospital records covering admissions between 1920 and 1982 for depression was analyzed in order to assess the switch rate to hypomania/mania. The results are the following: (1) Over the decades of this century there has been a substantial increase in hospital admissions in Zurich for both depression and mania, but the ratio remained constant. (2) Due to this increase the clinicians can observe more spontaneous switches from depression to mania, which favors the assumption of a causal relationship when treatment is applied. (3) 64 of the 908 patients (7.0%) admitted for depression switched to hypomania or mania. Hypomania was observed in 48 cases (5.3%) and mania in 16 cases (1.7%). (4) The analysis of predisposing factors to a switch has resulted in a simple finding. Bipolar patients (including schizomanics) have an 8-fold higher switch rate (28.9%) than the unipolars (3.7%). The switchers are equally distributed over the two sexes and do not differ in the frequency of a family history of affective psychoses, schizophrenia, schizoaffective disorders, or suicide. (5) Bipolarity correlates positively with ‘higher number of previous episodes’, with ‘readmitted’ and with ‘switch’. Therefore, studies selecting readmissions [Lewis and Winokur 1982] overrepresent switchers purposely. (6) A loglinear analysis together with some univariate strategies show that over the decades (from 1920 to 1982) there was no significant increase in switches of unipolar or bipolar patients. In conclusion, there is no evidence for a treatment-induced switch. This result is in line with Prien et al. [1973] and with Lewis and Winokur [1982].

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Bipolar Disorders, Part I: Treatment of Bipolar Depression

“…As far as the switch rates reported with mood stabiliser monotherapy are concerned, they appear to be between 0 and 5 IN), with lithium probably being the most effective in switch prevention (Calabrese et a1 1999b). The natural risk of a switch into mania during recovery from a bipolar depression has been estimated to be between 4 and 8 I%) (Angst 1985;Bunney et a1 1972). Antidepressant monotherapy without an accompanying mood stabiliser, however, may increase this switch risk significantly (Lewis and Winokur 1982;Wehr and Goodwin 1987).…”

“…Especially in very severe and psychotic depression, or in depression with severe psychomotor retardation, ECT has its major role. The switch risk is relatively high (around 7 I%, Angst 1985), but protective lithium co-administration may increase the risk and duration of a transient post-ECT delirium. The readiness to use ECT is quite different in different countries and mainly reflects public opinion and not its usefulness.…”

WFSBP Guidelines for Biological Treatment of Bipolar Disorders Part I - Treatment of Bipolar Depression

“…With regard to the switch rates reported with mood stabiliser monotherapy, they appear to be between 0% and 5%, with lithium probably being the most effective in switch prevention. 54 The natural risk of a switch into mania during recovery from a bipolar depression has been estimated to be between 4% and 8%, 55,56 and antidepressant monotherapy without an accompanying mood stabiliser may increase this switch risk significantly. 57,58 However, the highest reported switch rates (up to 70%) originate from a time when treatments with a TCA or irreversible MAO inhibitor were the only options.…”

“…84,85 Especially in very severe and psychotic depression or in depression with severe psychomotor retardation, ECT has its major role. The switch risk is relatively high (approximately 7%) 55 , but protective lithium co-administration may increase the risk and duration of a transient post-ECT delirium. The readiness to use ECT varies between different countries and mainly reflects public opinion and not its usefulness.…”

A History of the Use of Anticonvulsants as Mood Stabilizers in the Last Two Decades of the 20th Century

“…However, switching into mania the concept of the potential psychotropic effects of the anticonvulsant phenytoin. These studies were based largeand cycle acceleration appear to be more prevalent in those patients with initial rapid or continuous cycling ly on uncontrolled observations, although at least one of the schizoaffective patients reported in the literature had patterns, and a number of investigators have not observed a significant problem with switching or cycle acceleration consistent improvement on drug with exacerbations off it, highly suggestive of a clearly positive psychotropic in patients with more episodic illness [16][17][18].…”