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The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer
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2014 (English)In: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, Vol. 171, no 10, 1067-1073 p.Article in journal (Refereed) Published
Abstract [en]

Objective: This study examined the risk of antidepressant-induced manic switch in patients with bipolar disorder treated either with antidepressant monotherapy or with an antidepressant in conjunction with a mood stabilizer.

Method: Using Swedish national registries, the authors identified 3,240 patients with bipolar disorder who started treatment with an antidepressant and had no antidepressant treatment during the previous year. Patients were categorized into those receiving antidepressant monotherapy and those receiving an antidepressant plus a mood stabilizer. A within-individual design was used to control for confounding by disorder severity, genetic makeup, and early environmental factors. Cox regression analyses conditioned on individual were used to compare the rate of mania 0-3 months and 3-9 months after the start of antidepressant treatment with a preceding non-treatment period.

Results: Nearly 35% of the patients were treated with antidepressant monotherapy. The increased risk of treatment-emergent mania was confined to patients on antidepressant monotherapy (hazard ratio=2.83, 95% CI=1.12, 7.19). Among patients treated with a concurrent mood stabilizer, no acute change in risk of mania was observed during the 3 months after the start of antidepressant treatment (hazard ratio=0.79, 95% CI=0.54, 1.15), and a decreased risk was observed during the period 3-9 months after treatment initiation (hazard ratio=0.63, 95% CI=0.42, 0.93).

Conclusions: In this national registry study, antidepressant monotherapy was associated with an increased risk of mania. However, no risk of mania was seen in patients receiving an antidepressant while treated with a mood stabilizer. The results highlight the importance of avoiding antidepressant monotherapy in the treatment of bipolar disorder.

Place, publisher, year, edition, pages
Arlington, USA: American Psychiatric Publishing, 2014. Vol. 171, no 10, 1067-1073 p.
National Category
Medical and Health Sciences Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-54593DOI: 10.1176/appi.ajp.2014.13111501ISI: 000342713800011PubMedID: 24935197Scopus ID: 2-s2.0-84907486027OAI: oai:DiVA.org:oru-54593DiVA: diva2:1064419
Funder
Eli Lilly
Note

Funding Agencies:

Agency for Healthcare Research and Quality 

Alkermes 

Forest Pharmaceuticals 

NIMH 

Otsuka 

PharmaNeuroboost 

Roche 

Swedish Medical Research Council 

Swedish Foundation for Strategic Research 

Swedish Brain Foundation 

Available from: 2017-01-12 Created: 2017-01-12 Last updated: 2017-10-18Bibliographically approved

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