title: Treatment-emergent mania/hypomania during antidepressant treatment with transcranial direct current stimulation (tDCS): A systematic review and meta-analysis.
abstract: Treatment-emergent mania/hypomania (TEM) is a possible adverse effect of pharmacological and non-pharmacological antidepressant treatments.
  
  
  
  We performed a systematic review and meta-analysis to evaluate the risk of TEM in depressed patients during randomized, sham-controlled trials (RCTs).
  
  
  
  Medline database, from the first date available to August 12, 2016.
  
  
  
  From 283 references, 10 RCTs were identified. Only 3 of them described TEM. In active and sham groups, respectively, only 8 of 226 (3.5%) and 1 of 190 (0.5%) participants presented TEM. This difference was not statistically significant (OR = 1.79, 95% CI = 0.6 to 5.32). There were also five additional reports of TEM in participants not on RCTs. No risk factors for TEM were identified.
  
  
  
  Low number of studies and TEM reports.
  
  
  
  Despite previous reports, active vs. sham tDCS was not associated with a significantly greater number of TEM episodes.
authors.affiliation: Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil. Electronic address: brunoni@usp.br.
authors.forename: André R
authors.initials: AR
authors.lastname: Brunoni
authors.affiliation: Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil.
authors.forename: Adriano H
authors.initials: AH
authors.lastname: Moffa
authors.affiliation: Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil; Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Sampaio-Júnior
authors.affiliation: School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia.
authors.forename: Verònica
authors.initials: V
authors.lastname: Gálvez
authors.affiliation: School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, Australia; St George Hospital, Sydney, Australia.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: Loo
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology*; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D065908:Transcranial Direct Current Stimulation / Q000009:adverse effects*
chemical_list: D000928:Antidepressive Agents
keywords: Bipolar disorder; Major depressive disorder; Manic switch; Transcranial direct current stimulation; Treatment-emergent mania