title: Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: a review.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Searching computerized literature databases, followed by summary analyses.
  
  
  RESULTS
  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; p<0.0001). 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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA. rbaldessarini@mclean.harvard.edu
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
authors.forename: Gianni L
authors.initials: GL
authors.lastname: Faedda
authors.forename: Emanuela
authors.initials: E
authors.lastname: Offidani
authors.forename: Gustavo H
authors.initials: GH
authors.lastname: Vázquez
authors.forename: Ciro
authors.initials: C
authors.lastname: Marangoni
authors.forename: Giulia
authors.initials: G
authors.lastname: Serra
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tondo
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000139:chemically induced*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents