Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-15T01:22:13.545Z Has data issue: false hasContentIssue false
  • English
  • Français

Switching, Induction of Rapid Cycling, and Increased Suicidality With Antidepressants in Bipolar Patients: Fact or Overinterpretation?

Published online by Cambridge University Press:  07 November 2014

Heinz C.R. Grunze
Get access Rights & Permissions [Opens in a new window]

Abstract

Antidepressants constitute a central cornerstone in the treatment of depressive syndromes. In bipolar patients, however, there is an ongoing controversy about their usefulness for at least 3 decades. Early reports, mainly concerning tricyclic antidepressants, have repeatedly pointed toward unfavorable side effects on the course of the disorder, namely switching into (hypo)mania, induction of rapid cycling, and increased risk of suicide. Most evidence for both unfavorable and favorable effects has been deducted, thus far, from small studies with methodological flaws. More substantiated evidence only recently became available. From this it appears that, at least, the switch risk, and perhaps also the risk for rapid cycling and new-onset suicidality have been overinterpreted. At the same time, these new data raise doubt about the efficacy of anti-depressants as a primary-treatment choice in bipolar depression.

Type
Review Articles
Information
CNS Spectrums , Volume 13 , Issue 9 , September 2008 , pp. 790 - 795
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Möller, H-J, Grunze, H. Have some guidelines for the treatment of acute bipolar depression gone too far in the restriction of antidepressants? Eur Arch Psychiatry Clin Neurosci. 2000;250:57–68.Google ScholarPubMed
2.Möller, HJ, Grunze, H, Broich, K. Do recent efficacy data on the drug treatment of acute bipolar depression support the position that drugs other than antidepressants are the treatment of choice? A conceptual review. Eur Arch Psychiatry Clin Neurosci. 2006;256:1–16.CrossRefGoogle Scholar
3.Ghaemi, SN, Lenox, MS, Baldessarini, RJ. Effectiveness and safety of long-term antide-pressant treatment in bipolar disorder. J Clin Psychiatry. 2001;62:565–569.Google Scholar
4.McElroy, SL, Young, AH, Carlsson, A, et al.A double-blind, placebo-controlled study with acute and continuation phase of quetiapine and paroxetine in adults with bipolar deprsssion (EMBOLDEN II). Bipolar Disord. 2008; 10(suppl 1):59.Google Scholar
5.Bauer, MS, Wisniewski, SR, Marangell, LB, et al.Are antidepressants associated with new-onset suicidality in bipolar disorder? A prospective study of participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). J Clin Psychiatry. 2006;67:48–55.CrossRefGoogle ScholarPubMed
6.Sachs, GS, Nierenberg, AA, Calabrese, JR, et al.Effectiveness of adjunctive antidepressant treatment for bipolar depression. W Engl J Med. 2007;356:1711–1722.Google Scholar
7.Peet, M. Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants. Br J Psychiatry. 1994;164:549–550.Google Scholar
8.Bottlender, R, Rudolf, D, Strauß, A, Möller, H-J. Antidepressant-associated maniform states in acute treatment of patients with bipolar I depression. Eur Arch Psychiatry Clin Neurosci. 1998;248:296–300.CrossRefGoogle ScholarPubMed
9.Boerlin, HL, Gitlin, MJ, Zoellner, LA, Hammen, CL. Bipolar depression and antidepressantinduced mania: a naturalistic study. J Clin Psychiatry. 1998;59:374–349.Google Scholar
10.Kupfer, DJ, Carpenter, LL, Frank, E. Possible role of antidepressants in precipitating mania and hypomania in recurrent depression. Am J Psychiatry. 1988;145:804–808.Google Scholar
11.Lewis, JL, Winokur, G. The induction of mania. A natural history study with controls. Arch Gen Psychiatry. 1982;39:303–306.Google Scholar
12.Angst, J, Angst, K, Baruffol, I, Meinherz-Surbeck, R. ECT-induced and drug-induced hypomania. Convuls Ther. 1992;8:179–185.Google ScholarPubMed
13.Möller, HJ, Bottlender, R, Grunze, H, Strauss, A, Wittmann, J. Are antidepressants less effective in the acute treatment of bipolar I compared to unipolar depression? J Affect Disord. 2001;67:141–146.CrossRefGoogle ScholarPubMed
14.Leverich, GS, Altshuler, LL, Frye, MA, et al.Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. Am J Psychiatry. 2006;163:232–239.Google Scholar
15.Vieta, E, Martinez-Aran, A, Goikolea, JM, et al.A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry. 2002;63:508–512.CrossRefGoogle ScholarPubMed
16.Dunner, DL, D'Souza, DN, Kajdasz, DK, Detke, MJ, Russell, JM. Is treatment-associated hypomania rare with duloxetine: secondary analysis of controlled trials in non-bipolar depression. J Affect Disord. 2005;87:115–119.CrossRefGoogle ScholarPubMed
17.Grunze, H, Kasper, S, Goodwin, G, et al.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of bipolar disorders. Part I: Treatment of bipolar depression. World J Biol Psychiatry. 2002;3:115–124.CrossRefGoogle ScholarPubMed
18.Altshuler, LL, Suppes, T, Black, DO, et al.Lower switch rate in depressed patients with bipolar II than bipolar I disorder treated adjunctively with second-generation antidepressants. Am J Psychiatry. 2006;163:313–315.CrossRefGoogle ScholarPubMed
19.Serretti, A, Artioli, P, Zanardi, R, Rossini, D. Clinical features of antidepressant associated manic and hypomanic switches in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27:751–757.Google Scholar
20.Gijsman, HJ, Geddes, JR, Rendell, JM, Nolen, WA, Goodwin, GM. Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. Am J Psychiatry. 2004;161:1537–1547.CrossRefGoogle ScholarPubMed
21.Tohen, M, Vieta, E, Calabrese, J, et al.Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Arch Gen Psychiatry. 2003;60:1079–1088.Google Scholar
22.Tohen, M, Frank, E, Bowden, CL, et al.The International Society of Bipolar Disorders (ISBD) Task Force on the Nomenclature of Course and Outcome in Bipolar Disorders. Bipolar Disord. In press.Google Scholar
23.El-Mallakh, RS, Ghaemi, SN, Sagduyu, K, et al.Antidepressant-associated chronic irritable dysphoria (ACID) in STEP-BD patients. J Affect Disord. 2008 Jun 17. [Epub ahead of print].CrossRefGoogle ScholarPubMed
24.Frye, M, Leverich, G, Altshuler, L, et al.Minimal manic symptoms in bipolar depression associated with antidepressant treatment-emergent mania. Am J Psychiatry. In press.Google Scholar
25.Dunner, DL, Fieve, RR. Clinical factors in lithium carbonate prophylaxis failure. Arch Gen Psychiatry. 1974;30:229–233.Google Scholar
26.Schneck, CD, Miklowitz, DJ, Miyahara, S, et al.The prospective course of rapid-cycling bipolar disorder: findings from the STEP-BD. Am J Psychiatry. 2008;165:370–377.Google Scholar
27.Kupka, RW, Luckenbaugh, DA, Post, RM, et al.Comparison of rapid-cycling and non-rapid-cycling bipolar disorder based on prospective mood ratings in 539 outpatients. Am J Psychiatry. 2005;162:1273–1280.Google Scholar
28.Wehr, TA, Goodwin, FK. Rapid cycling in manic-depressives induced by tricyclic antide-pressants. Arch Gen Psychiatry. 1979;36:555–559.CrossRefGoogle Scholar
29.Tondo, L, Laddomada, P, Serra, G, Minnai, G, Kukopulos, A. Rapid cyclers and antidepressants. Int Pharmacopsychiatry. 1981;16:119–123.CrossRefGoogle ScholarPubMed
30.Kukopulos, A, Caliari, B, Tundo, A, et al.Rapid cyclers, temperament, and antidepressants. Compr Psychiatry. 1983;24:249–258.CrossRefGoogle ScholarPubMed
31.Altshuler, LL, Post, RM, Leverich, GS, Mikalauskas, K, Rosoff, A, Ackerman, L. Antidepressant-induced mania and cycle acceleration: a controversy revisited. Am J Psychiatry. 1995;152:1130–1138.Google Scholar
32.Hurowitz, GI, Liebowitz, MR. Antidepressant-induced rapid cycling: six case reports. J Clin Psychopharmacol. 1993;13:52–56.CrossRefGoogle ScholarPubMed
33.Mattes, JA. Antidepressant-induced rapid cycling: another perspective. Ann Clin Psychiatry. 2006;18:195–199.Google Scholar
34.Coryell, W, Solomon, D, Turvey, C, et al.The long-term course of rapid-cycling bipolar disorder. Arch Gen Psychiatry. 2003;60:914–920.Google Scholar
35.Ghaemi, SN. Treatment of rapid-cycling bipolar disorder: are antidepressants mood destabilizers? Am J Psychiatry. 2008;165:300–302.CrossRefGoogle ScholarPubMed
36.Altshuler, LL, Post, RM, Hellemann, G, et al.Impact of antidepressant continuation after acute positive or partial treatment response for bipolar depression: a blinded, randomized study. J Clin Psychiatry. In press.Google Scholar
37.Angst, J, Angst, F, Gerber-Werder, R, Gamma, A. Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years' follow-up. Arch Suicide Res. 2005;9:279–300.Google Scholar
38.Ludwig, J, Marcotte, DE. Anti-depressants, suicide, and drug regulation. J Policy Anal Manage. 2005;24:249–272.CrossRefGoogle ScholarPubMed
39.Healy, D, Whitaker, C. Antidepressants and suicide: risk-benefit conundrums. J Psychiatry Neurosci. 2003;28:331–337.Google ScholarPubMed
40.Hall, WD, Lucke, J. How have the selective serotonin reuptake inhibitor antidepressants affected suicide mortality? Aust N Z J Psychiatry. 2006;40:941–950.Google Scholar
41.Möller, HJ. Is there evidence for negative effects of antidepressants on suicidality in depressive patients? A systematic review. Eur Arch Psychiatry Clin Neurosci. 2006;256:476–496.Google Scholar
42.Fergusson, D, Doucette, S, Glass, KC, et al.Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ. 2005;330:396.CrossRefGoogle ScholarPubMed
43.Gunnell, D, Saperia, J, Ashby, D. Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA's safety review. BMJ. 2005;330:385.Google Scholar
44.Hammad, TA, Laughren, T, Racoosin, J. Suicidality in pediatric patients treated with anti-depressant drugs. Arch Gen Psychiatry. 2006;63:332–339.Google Scholar
45.Gibbons, RD, Brown, CH, Hur, K, et al.Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry. 2007;164:1356–1363.Google Scholar
46.Wheeler, BW, Gunnell, D, Metcalfe, C, Stephens, P, Martin, RM. The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom: ecological study. BMJ. 2008;336:542–545.CrossRefGoogle ScholarPubMed
47.Yerevanian, BI, Koek, RJ, Mintz, J, Akiskal, HS. Bipolar pharmacotherapy and suicidal behavior Part 2. The impact of antidepressants. J Affect Disord. 2007;103:13–21.CrossRefGoogle ScholarPubMed
48.Kochman, FJ, Hantouche, EG, Ferrari, P, Lancrenon, S, Bayart, D, Akiskal, HS. Cyclothymic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder. J Affect Disord. 2005;85:181–189.Google Scholar