title: The number of past manic episodes is the best predictor of antidepressant-emergent manic switch in a cohort of bipolar depressed patients.
abstract: The present study sought to identify factors associated with the onset of a manic or hypomanic episode during the month following a new antidepressant therapy in depressed bipolar patients. Patients receiving mood stabilizers for ≥3 months were screened from 400 French centers and were assessed for a 4-week period following prescription of a first or a new antidepressant. Of the 1242 included participants, 4.8% (n=60) experienced antidepressant-emergent manic switch (AEMS). AEMS was more frequently associated with lifetime manic, depressive, and total mood episodes, and with past AEMS. A higher score at two items of the Montgomery-Åsberg Depression Rating Scale (pessimistic and suicidal thoughts) were significantly associated with AEMS. Logistic regression analysis showed that the number of lifetime manic episodes and past AEMS were the two most factors associated with an AEMS. Having more than four past manic episodes was associated with a 2.84 fold increased risk of AEMS. Cumulative number of past mood episodes seems to be the most important factor for switching to a manic episode following antidepressants in patients with bipolar disorder. Longer-term studies are required to further delineate antidepressant causality from natural disease course.
authors.affiliation: Sainte-Anne hospital, CMME, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U894, Paris, France.
authors.forename: Philip
authors.initials: P
authors.lastname: Gorwood
authors.affiliation: McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Douglas Institute, Frank B. Common Pavilion, 6875 LaSalle Boulevard, Montreal, Quebec, Canada H4H 1R3; Laboratoire de Psychologie des Pays de la Loire EA 4638, Université de Nantes et Angers, France. Electronic address: richarddevantoy@orange.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Richard-Devantoy
authors.affiliation: Département de Santé Mentale et de Psychiatrie, Service de Psychiatrie Générale, Centre Ambulatoire de la Jonction, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
authors.forename: Othman
authors.initials: O
authors.lastname: Sentissi
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM) U894, Paris, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Le Strat
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM) U894, Paris, France; Service Hospitalo - Universitaire (SHU), Sainte-Anne Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Olié
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D002220:Carbamazepine / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008875:Middle Aged; D019964:Mood Disorders / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology*
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents; D002220:Carbamazepine; D008094:Lithium
keywords: Antidepressive agents; Bipolar disorder; Drug therapy, Switch; Mood stabilizers; Recurrence