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RESEARCH PRODUCT
Clinical and psychopathological features associated with treatment-emergent mania in bipolar-II depressed outpatients exposed to antidepressants
Domenico De BerardisAndrea De BartolomeisFrancesco MonacoMarco SolmiAnnalisa AnastasiaAndrea FuscoStefano NovelloNicola VeroneseMichele FornaroFelice Iasevolisubject
AdultMalemedicine.medical_specialtyBipolar DisorderAdolescentLithium (medication)media_common.quotation_subjectTreatment-emergent-maniaAntidepressantGastroenterologyYoung Adult03 medical and health sciencesBipolar Disorder (BD) Antidepressant Depression Treatment-emergent-mania0302 clinical medicineInternal medicineRecall biasOutpatientsmedicineHumansBipolar disorderAgedmedia_commonAntidepressant; Bipolar Disorder (BD); Depression; Treatment-emergent-mania; Clinical Psychology; Psychiatry and Mental Healthbusiness.industryDepressionMiddle Agedmedicine.diseaseBipolar Disorder (BD)Antidepressive Agents030227 psychiatryClinical PsychologyCross-Sectional StudiesTreatment OutcomeTolerabilityPsychiatry and Mental HealthAntidepressantDrug Therapy CombinationFemaleTemperamentmedicine.symptombusinessMania030217 neurology & neurosurgeryAntipsychotic AgentsPsychopathologymedicine.drugdescription
Abstract Background Treatment-emergent affective switch (TEAS), including treatment-emergent mania (TEM), carry significant burden in the clinical management of bipolar depression, whereas the use of antidepressants raises both efficacy, safety and tolerability concerns. The present study assesses the prevalence and clinical correlates of TEM in selected sample of Bipolar Disorder (BD) Type-II (BD-II) acute depression outpatients. Methods Post-hoc analysis of the clinical and psychopathological features associated with TEM among 91 BD-II depressed outpatients exposed to antidepressants. Results Second-generation antipsychotics (SGA) (p = .005), lithium (≤ .001), cyclothymic/irritable/hyperthymic temperaments (p = ≤ .001; p = .001; p = .003, respectively), rapid-cycling (p = .005) and depressive mixed features (p = .003) differed between TEM+ cases vs. TEM− controls. Upon multinomial logistic regression, the accounted psychopathological features correctly classified as much as 88.6% of TEM+ cases (35/91 overall sample, or 38.46% of the sample), yet not statistically significantly [Exp(B) = .032; p = ns]. Specifically, lithium [B = − 2.385; p = .001], SGAs [B = − 2.354; p = .002] predicted lower rates of TEM+ in contrast to the number of lifetime previous psychiatric hospitalizations [B = 2.380; p = .002], whereas mixed features did not [B = 1.267; p = ns]. Limitations Post-hoc analysis. Lack of systematic pharmacological history record; chance of recall bias and Berkson's biases. Permissive operational criterion for TEM. Relatively small sample size. Conclusions Cyclothymic temperament and mixed depression discriminated TEM+ between TEM− cases, although only lithium and the SGAs reliably predicted TEM+/− grouping. Larger-sampled/powered longitudinal replication studies are warranted to allow firm conclusions on the matter, ideally contributing to the identification of clear-cut sub-phenotypes of BD towards patient-tailored-pharmacotherapy.
year | journal | country | edition | language |
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2018-01-01 |