Predictors of switch from depression to mania in bipolar disorder.
Manic switch is a relevant issue when treating bipolar depression. Some risk factors have been suggested, but unequivocal findings are lacking. We therefore investigated predictors of switch from depression to mania in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) sample. Manic switch was defined as a depressive episode followed by a (hypo)manic or mixed episode within the following 12 weeks. We assessed possible predictors of switch using generalized linear mixed models (GLMM). 8403 episodes without switch and 512 episodes with switch (1720 subjects) were included in the analysis. Several baseline variables were associated with a higher risk of switch. They were younger age, previous history of: rapid cycling, severe manic symptoms, suicide attempts, amphetamine use and some pharmacological and psychotherapeutic treatments. During the current depressive episode, the identified risk factors were: any possible mood elevation, multiple mania-associated symptoms with at least moderate severity, and comorbid panic attacks. In conclusion, our study suggests that both characteristics of the disease history and clinical features of the current depressive episode may be risk factors for manic switch.
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy; Research Center for Child Mental Development, Chiba University Graduate School of Medicine, Chiba, Japan.
Tomihisa
T
Niitsu
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
Chiara
C
Fabbri
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy. Electronic address: alessandro.serretti@unibo.it.
Alessandro
A
Serretti
D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D016584:Panic Disorder / Q000453:epidemiology / Q000523:psychology; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012306:Risk; D013406:Suicide, Attempted / Q000523:psychology; D014481:United States
D000928:Antidepressive Agents
Amphetamine use; Bipolar depression; Manic switch; Manic symptom; Onset; Panic attack; Rapid-cycling; Suicide; Venlafaxine