Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: A review

6533b7d7fe1ef96bd1268fad

RESEARCH PRODUCT

Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: A review

Gustavo H. Vázquez Gustavo H. Vázquez Giulia Serra Ross J. Baldessarini Emanuela Offidani Ciro Marangoni Leonardo Tondo Gianni L. Faedda Gianni L. Faedda

subject

Depressive Disorder Major medicine.medical_specialty Pediatrics Bipolar Disorder medicine.disease Risk Assessment behavioral disciplines and activities Antidepressive Agents Psychiatry and Mental health Clinical Psychology Treatment Outcome Mood Hypomania mental disorders medicine Humans Antidepressant Major depressive disorder Bipolar disorder medicine.symptom Psychiatry Psychology Mania Depression (differential diagnoses)Randomized Controlled Trials as Topic

description

Compare reported rates of mood-shifts from major depression to mania/hypomania/mixed-states during antidepressant (AD)-treatment and rates of diagnostic change from major depressive disorder (MDD) to bipolar disorder (BPD).Searching computerized literature databases, followed by summary analyses.In 51 reports of patients diagnosed with MDD and treated with an AD, the overall risk of mood-switching was 8.18% (7837/95,786) within 2.39 ± 2.99 years of treatment, or 3.42 (95% CI: 3.34-3.50) %/year. Risk was 2.6 (CI: 2.5-2.8) times greater with/without AD-treatment by meta-analysis of 10 controlled trials. Risk increased with time up to 24 months of treatment, with no secular change (1968-2012). Incidence rates were 4.5 (CI: 4.1-4.8)-times greater among juveniles than adults (5.62/1.26 %/year; p0.0001). In 12 studies the overall rate of new BPD-diagnoses was 3.29% (1928/56,754) within 5.38 years (0.61 [0.58-0.64] %/year), or 5.6-times lower (3.42/0.61) than annualized rates of mood-switching.AD-treatment was associated with new mania-like responses in 8.18% of patients diagnosed with unipolar MDD. Contributions to mood-switching due to unrecognized BPD versus mood-elevating pharmacological effects, as well as quantitative associations between switching and later diagnosis of BPD not associated with AD-treatment remain uncertain.Rates and definitions of mood-switching with ADs varied greatly, exposure-times rarely were precisely defined, and there was little information on predictive associations between mood-switches and BPD-diagnosis.

year	journal	country	edition	language
2012-10-05	Journal of Affective Disorders

https://doi.org/10.1016/j.jad.2012.10.033