Treatment-induced mania in bipolar depression: Identifying at-risk bipolar patients

Abstract

The treatment of bipolar depression is still an important challenge for clinicians and the number of evidence based options is limited. Antidepressants are the most frequently prescribed drugs for bipolar depression in clinical practice, even though the relative risks and benefits of using this treatment strategy has been strongly debated over the past 25 years. One of the reasons is that several placebo-controlled studies have shown that antidepressants could induce manic or hypomanic episodes and accelerate the rate of cycling, worsening the course of the illness by increasing the number of mood episodes over time. Antidepressant-Induced Manias (AIM) have been reported in a subgroup of about 25 to 30% of bipolar patients. There is an increased risk of mood switch with tricyclic antidepressants (TCAs) and serotonin and noradrenaline reuptake inhibitors (SNRIs). The occurrence of mania during antidepressant treatment is a crucial issue in the clinical management of Bipolar Disorder (BD) since it greatly interferes with the establishment of an optimal treatment for bipolar depression. It can have substantial negative impact on overall mood and psychosocial stability in patients receiving treatment for bipolar depression, possibly leading to treatment resistance. Therefore, the identification of clinical correlates associated with AIM is essential to better identify at-risk subgroups of patients and propose specific individualized treatment strategies for bipolar depression. No risk factors has been replicated so far, mostly because studies are characterized by small sample sizes and by the absence of a consensus definition of AIM, showing conflicting results. In this study, patients were classified according to a restrictive definition, similar to that used by Rousseva et al. (2003). An AIM− group (n = 135) was compared to AIM+ patients (n = 75) for clinical and sociodemographic factors as well as for psychological dimensions.