title: One-year outcomes of unipolar depression patients with manic or hypomanic switch during acute antidepressant treatment.
abstract: OBJECTIVE
  The aim of the study was to investigate one-year outcomes of unipolar depression patients with manic or hypomanic switch during acute antidepressant treatment.
  
  
  METHODS
  A review of medical records revealed 37 consecutive patients admitted from 1997 to 2002 who underwent an antidepressant-induced manic or hypomanic switch fulfilling DSM-IV criteria. Their clinical courses were retrospectively investigated after discharge.
  
  
  RESULTS
  Of the 37 patients, 33 (89.2%) were followed up for 1 year after discharge. None developed a manic episode, while seven developed a hypomanic episode, including 1 patient who was lost after emerging from a hypomanic episode within 6 months after discharge. Only one of those seven patients developed hypomania during acute antidepressant treatment for a recurrent depressive episode under maintenance mood stabilizer treatment. Furthermore, bipolar conversion occurred in four patients within the first 6 months and in another two patients, including 1 with rapid cycling, over the subsequent 6 months after discharge. Of these 33 patients, 28 received continuous maintenance treatment with mood stabilizers for the one-year period after discharge.
  
  
  CONCLUSIONS
  The subjects were considered to have a bipolar nature according to the prevalence rate of bipolar conversion over a one-year period. Longer follow-up studies appear warranted determine the diagnostic issues of antidepressant-induced switch in unipolar depression.
authors.affiliation: Department of Psychiatry, Hiroshima City Hospital, Moto-machi, Naka-ku, Hiroshima 730-8518, Japan. kenwada1222@sepia.megaegg.ne.jp
authors.forename: Ken
authors.initials: K
authors.lastname: Wada
authors.forename: Takanobu
authors.initials: T
authors.lastname: Sasaki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Jitsuiki
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takaishi
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D018692:Antimanic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000139:chemically induced*; D003527:Cyclothymic Disorder / Q000139:chemically induced; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents