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Which antidepressants are associated with increased risk of developing mania? A retrospective electronic case register cohort study

Published online by Cambridge University Press:  23 March 2020

R. Patel ,
P. Reiss ,
H. Shetty ,
M. Broadbent ,
R. Stewart ,
P. McGuire  and
M. Taylor
R. Patel*
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, United Kingdom
P. Reiss
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, United Kingdom
H. Shetty
Affiliation:
South London and Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, United Kingdom
M. Broadbent
Affiliation:
South London and Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, United Kingdom
R. Stewart
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom
P. McGuire
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, United Kingdom
M. Taylor
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

The symptoms of bipolar disorder are sometimes misrecognised for unipolar depression and inappropriately treated with antidepressants. This may be associated with increased risk of developing mania. However, the extent to which this depends on what type of antidepressant is prescribed remains unclear.

Aims

To investigate the association between different classes of antidepressants and subsequent onset of mania/bipolar disorder in a real-world clinical setting.

Methods

Data on prior antidepressant therapy were extracted from 21,012 adults with unipolar depression receiving care from the South London and Maudsley NHS Foundation Trust (SLaM). multivariable Cox regression analysis (with age and gender as covariates) was used to investigate the association of antidepressant therapy with risk of developing mania/bipolar disorder.

Results

In total, 91,110 person-years of follow-up data were analysed (mean follow-up: 4.3 years). The overall incidence rate of mania/bipolar disorder was 10.9 per 1000 person-years. The peak incidence of mania/bipolar disorder was seen in patients aged between 26 and 35 years (12.3 per 1000 person-years). The most frequently prescribed antidepressants were SSRIs (35.5%), mirtazapine (9.4%), venlafaxine (5.6%) and TCAs (4.7%). Prior antidepressant treatment was associated with an increased incidence of mania/bipolar disorder ranging from 13.1 to 19.1 per 1000 person-years. Multivariable analysis indicated a significant association with SSRIs (hazard ratio 1.34, 95% CI 1.18–1.52) and venlafaxine (1.35, 1.07–1.70).

Conclusions

In people with unipolar depression, antidepressant treatment is associated with an increased risk of subsequent mania/bipolar disorder. These findings highlight the importance of considering risk factors for mania when treating people with depression.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
EW447
Information
European Psychiatry , Volume 33 , Issue S1: Abstracts of the 24th European Congress of Psychiatry , March 2016 , pp. s228 - s229
Copyright
Copyright © European Psychiatric Association 2014
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