title: Antidepressant treatment-emergent affective switch in bipolar disorder: a prospective case-control study of outcome.
abstract: OBJECTIVE
  Treatment-emergent affective switch has been associated to cycle acceleration and poorer outcome, but there are few studies addressing this issue. The aim of this study was to prospectively compare the outcome of patients presenting treatment-emergent affective switch with patients with spontaneous mania, regarding presence and polarity of a new episode and time to relapse.
  
  
  METHODS
  Twenty-four patients with bipolar disorder according to the DSM-IV were followed for 12 months. Twelve patients had treatment-emergent affective switch and twelve had spontaneous mania. Patients were evaluated weekly with the Young Mania Rating Scale and the Hamilton Depression Scale until remission of the index episode, and monthly until completion of the 12-month follow-up.
  
  
  RESULTS
  Eleven patients with treatment-emergent affective switch had a recurrence on follow-up, all of them with major depressive episodes. In the group with spontaneous mania, six patients had a recurrence: two had a depressive episode, and four had a manic episode (p = 0.069 for new episode, p = 0.006 for polarity of the episode). Patients with treatment-emergent affective switch relapsed in a shorter period than patients with spontaneous mania (p = 0.016).
  
  
  CONCLUSIONS
  In this first prospective study, treatment-emergent affective switch patients were at greater risk of relapses, especially depressive episodes, and presented a shorter duration of remission when compared with patients with spontaneous mania.
authors.affiliation: Bipolar Disorder Research Program, Institute of Psychiatry, Hospital das Clínicas, Medical School, Universidade de São Paulo, Brazil. rstamada@uol.com.br
authors.forename: Renata Sayuri
authors.initials: RS
authors.lastname: Tamada
authors.forename: José Antônio
authors.initials: JA
authors.lastname: Amaral
authors.forename: Cilly Kluger
authors.initials: CK
authors.lastname: Issler
authors.forename: Andrew Alan
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000523:psychology; D016022:Case-Control Studies; D003527:Cyclothymic Disorder / Q000139:chemically induced; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents