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Olgiati P, Serretti A. Antidepressant emergent mood switch in major depressive disorder: onset, clinical correlates and impact on suicidality. Int Clin Psychopharmacol 2023; 38:342-351. [PMID: 37351585 PMCID: PMC10373846 DOI: 10.1097/yic.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/08/2023] [Indexed: 06/24/2023]
Abstract
Antidepressant (AD)- emergent mood switch (AEMS) is a common complication of bipolar depression. This study aimed to investigate the prevalence and clinical correlates of subthreshold AEMS (i.e. not fulfilling DSM criteria for hypomanic episodes) in major depressive disorder (MDD) and, prognostically, its impact on AD treatment outcome and suicidality. The study involved 425 outpatients with MDD followed during the acute phase (12 weeks) and continuation (weeks 13-28) AD treatment. AEMS was assessed through the Altman Self-Rating Mania scale (ASRM ≥ 6). Several clinical features differentiated individuals with or without subthreshold AEMS (n = 204 vs. 221): negative self-perception [odds ratio (OR) 1.017-1.565]; panic disorder (OR 1.000-1.091); subthreshold hypomanic episodes (OR 1.466-13.352); childhood emotional abuse (OR 1.053-2.447); lifetime suicidal behaviour (OR 1.027-1.236); AD-related remission (χ 2 = 22.903 P < 0.0001) and suicide ideation (χ 2 = 16.701 P < 0.0001). In AEMS earlier onset showed a strong correlation with bipolar spectrum disorder (overall score: P = 0.0053; mixed depression: P = 0.0154; subthreshold hypomania: P = 0.0150) whereas late-onset was associated with more severe suicidal behaviour ( P < 0.001). In conclusion, our results demonstrate that subthreshold mood switches occur frequently in unipolar depression during acute AD treatment as well as in continuation phase. Time of switch onset seems to have the greatest diagnostic and prognostic value.
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Affiliation(s)
- Paolo Olgiati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Chakrabarti S. Bipolar disorder in the International Classification of Diseases-Eleventh version: A review of the changes, their basis, and usefulness. World J Psychiatry 2022; 12:1335-1355. [PMID: 36579354 PMCID: PMC9791613 DOI: 10.5498/wjp.v12.i12.1335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 12/16/2022] Open
Abstract
The World Health Organization’s 11th revision of the International Classification of Diseases (ICD-11) including the chapter on mental disorders has come into effect this year. This review focuses on the “Bipolar or Related Disorders” section of the ICD-11 draft. It describes the benchmarks for the new version, particularly the foremost principle of clinical utility. The alterations made to the diagnosis of bipolar disorder (BD) are evaluated on their scientific basis and clinical utility. The change in the diagnostic requirements for manic and hypomanic episodes has been much debated. Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear. The ICD-11 definition of depressive episodes is substantially different, but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low. Unlike the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the ICD-11 has retained the category of mixed episodes. Although the concept of mixed episodes in the ICD-11 is not perfect, it appears to be more inclusive than the DSM-5 approach. Additionally, there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder. The initial results on the reliability and clinical utility of BD are promising, but the newly created diagnostic categories also appear to have some limitations. Although further improvement and research are needed, the focus should now be on facing the challenges of implementation, dissemination, and education and training in the use of these guidelines.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, UT, India
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3
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Yalçın M, Oğuz A, Beştepe EE, Sağlam NGU, Ergelen M. Black cohosh associated mania in a patient with unipolar depression. Int J Psychiatry Med 2021; 56:67-72. [PMID: 32955954 DOI: 10.1177/0091217420961185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Black cohosh (actaea racemosa, cimicifuga racemosa) a popular complementary medicine, is commonly prescribed as an alternative drug to hormone replacement therapy for the treatment of menopause symptoms and menstrual pain. Studies on the black cohosh's psychological effects are generally focused on the perimenopausal depression and anxiety; and, its effects have been considered to be affiliated with its serotonergic and dopaminergic activities. We report a patient presenting with acute onset mania associated with black cohosh use, probably due to its psychopharmacological activities on serotonergic and dopaminergic receptors. We suggest that black cohosh must be used cautiously in the patients with history of unipolar depression or bipolar disorder.
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Affiliation(s)
- Murat Yalçın
- Psychiatry Department, Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Ayşenur Oğuz
- Psychiatry Department, Istanbul Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Engin Emrem Beştepe
- Psychiatry Department, Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Nazife Gamze Usta Sağlam
- Psychiatry Department, Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Mine Ergelen
- Psychiatry Department, Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
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Fornaro M, Anastasia A, Monaco F, Novello S, Fusco A, Iasevoli F, De Berardis D, Veronese N, Solmi M, de Bartolomeis A. Clinical and psychopathological features associated with treatment-emergent mania in bipolar-II depressed outpatients exposed to antidepressants. J Affect Disord 2018. [PMID: 29525354 DOI: 10.1016/j.jad.2018.02.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Treatment-emergent affective switch (TEAS), including treatment-emergent mania (TEM), carry significant burden in the clinical management of bipolar depression, whereas the use of antidepressants raises both efficacy, safety and tolerability concerns. The present study assesses the prevalence and clinical correlates of TEM in selected sample of Bipolar Disorder (BD) Type-II (BD-II) acute depression outpatients. METHODS Post-hoc analysis of the clinical and psychopathological features associated with TEM among 91 BD-II depressed outpatients exposed to antidepressants. RESULTS Second-generation antipsychotics (SGA) (p = .005), lithium (≤ .001), cyclothymic/irritable/hyperthymic temperaments (p = ≤ .001; p = .001; p = .003, respectively), rapid-cycling (p = .005) and depressive mixed features (p = .003) differed between TEM+ cases vs. TEM- controls. Upon multinomial logistic regression, the accounted psychopathological features correctly classified as much as 88.6% of TEM+ cases (35/91 overall sample, or 38.46% of the sample), yet not statistically significantly [Exp(B) = .032; p = ns]. Specifically, lithium [B = - 2.385; p = .001], SGAs [B = - 2.354; p = .002] predicted lower rates of TEM+ in contrast to the number of lifetime previous psychiatric hospitalizations [B = 2.380; p = .002], whereas mixed features did not [B = 1.267; p = ns]. LIMITATIONS Post-hoc analysis. Lack of systematic pharmacological history record; chance of recall bias and Berkson's biases. Permissive operational criterion for TEM. Relatively small sample size. CONCLUSIONS Cyclothymic temperament and mixed depression discriminated TEM+ between TEM- cases, although only lithium and the SGAs reliably predicted TEM+/- grouping. Larger-sampled/powered longitudinal replication studies are warranted to allow firm conclusions on the matter, ideally contributing to the identification of clear-cut sub-phenotypes of BD towards patient-tailored-pharmacotherapy.
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Affiliation(s)
- Michele Fornaro
- New York State Psychiatric Institute, Columbia University, NYC, NY, USA; Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Annalisa Anastasia
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Francesco Monaco
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neuroscience, University of Salerno, Salerno, Italy.
| | - Stefano Novello
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Andrea Fusco
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Felice Iasevoli
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, 64100 Teramo, Italy.
| | | | - Marco Solmi
- Azienda Ospedaliera di Padova, Padua Hospital, Psychiatry Unit, Padua, Italy.
| | - Andrea de Bartolomeis
- Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
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5
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Yamaguchi Y, Kimoto S, Nagahama T, Kishimoto T. Dosage-related nature of escitalopram treatment-emergent mania/hypomania: a case series. Neuropsychiatr Dis Treat 2018; 14:2099-2104. [PMID: 30147322 PMCID: PMC6103304 DOI: 10.2147/ndt.s168078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Several studies have documented that treatment with various antidepressant agents can result in mood switching during major depressive episodes. Escitalopram, one of the newer selective serotonin reuptake inhibitors (SSRIs), is considered preferable due to its relatively high efficacy and acceptability. Although a few cases of escitalopram treatment-emergent mania have been reported, it remains unknown whether this effect is dose-related. METHOD In the present report, we discuss three cases of treatment-emergent mania/hypomania in patients receiving escitalopram for major depressive episodes. No patients had a family or personal history of bipolar disorder. RESULTS In all three cases, manic or hypomanic symptoms emerged within 1 month right after the dosage of escitalopram was increased to 20 mg/day. Moreover, manic episodes subsided as the dosage of escitalopram was reduced. Mood switching was not observed after the cessation of escitalopram treatment. CONCLUSION Our case series indicates that escitalopram may induce treatment-emergent mania/hypomania in a dose-related manner. Treatment at lower doses and with careful upward titration might be favorable in certain patients with bipolar depression and major depressive disorder in order to minimize the risk of mood switching.
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Affiliation(s)
- Yasunari Yamaguchi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan,
| | - Sohei Kimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan,
| | - Takeshi Nagahama
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan,
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan,
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Barbuti M, Pacchiarotti I, Vieta E, Azorin JM, Angst J, Bowden CL, Mosolov S, Young AH, Perugi G. Antidepressant-induced hypomania/mania in patients with major depression: Evidence from the BRIDGE-II-MIX study. J Affect Disord 2017; 219:187-192. [PMID: 28558366 DOI: 10.1016/j.jad.2017.05.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/12/2017] [Accepted: 05/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The issue of antidepressant-induced mood switches to hypomania, mania, or mixed states within the course of mayor depressive disorder (MDD) has been a controversial topic. The present post-hoc analysis of the BRIDGE-II-MIX study focuses on the clinical features of patients with history of antidepressant-induced hypomania/mania (AIHM) in a large international sample of patients with major depressive episode (MDE). METHODS 2811 subjects with major depression were enrolled in this multicentre cross-sectional study. Current mixed symptoms, socio-demographic and other clinical variables were collected and compared among MDD-AIHM, MDD and BD patients. RESULTS 475 patients out of 2811 had history of AIHM (16.90%). In the MDD-AIHM group, familiarity for BD and rates of atypical features and comorbid anxiety, eating and borderline personality disorders were similar to BD and significantly more frequent compared to MDD group. MDD-AIHM patients had more frequently more than 3 episodes and reported higher rates of treatment resistance, mood lability and irritability following treatment with antidepressants. Frequencies of depression with mixed features and (hypo)manic symptoms were similar in patients of MDD-AIHM and BD groups and significantly higher in both groups than in MDD. LIMITATIONS there were widely varying rates of hospitalized patients across countries and the participating centres were not randomly selected. CONCLUSIONS Our results strongly support the DSM-5 inclusion of MDD patients with AIHM within the rubric of bipolar disorder. Differences with other MDD and BD were also observed suggesting the possibility that MDD-AIHM may represent a specific sub-population, particularly sensitive to exogenous input from antidepressants.
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Affiliation(s)
- Margherita Barbuti
- University of Pisa, Pisa, Italy; Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Isabella Pacchiarotti
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Jules Angst
- Psychiatric Hospital, University of Zurich, Switzerland
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7
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Scott J, Brichant-Petitjean C, Etain B, Henry C, Kahn JP, Azorin JM, Leboyer M, Bellivier F. A re-examination of antidepressant treatment-emergent mania in bipolar disorders: evidence of gender differences. Acta Psychiatr Scand 2017; 135:479-488. [PMID: 28369709 DOI: 10.1111/acps.12728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To explore the prevalence and clinical profile of males and females who develop antidepressant treatment-emergent mania (ATEM). METHOD From an original sample of 754 patients with BD, we identified ATEM+ cases (n = 75) and ATEM- controls (n = 135) that met stringent criteria. We specifically examined the combinations of clinical factors that best classified males and females as ATEM+ cases. RESULTS Seventy-five individuals were classified as ATEM+; 87% of ATEM events occurred during antidepressant monotherapy. Regression analyses demonstrated that the presence of an alcohol and/or substance use disorder [Odds Ratio (OR) 6.37], a history of one or more suicide attempts (OR 4.19) and higher number of depressive episodes per year of illness (OR 1.71) correctly classified 73% of males. In contrast, 84% of females were correctly classified on the basis of a positive history of thyroid disorder (OR 3.23), a positive family history of BD I (OR 2.68) and depressive onset polarity (OR 2.01). CONCLUSION Using stringent definitions of ATEM status to reduce the probability of inclusion of false-positive cases and false-negative controls, we identified for the first time that the risk profiles for the development of an ATEM differ significantly according to gender.
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Affiliation(s)
- J Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Centre for Affective Disorders, IoPPN, Kings College, London, UK
| | - C Brichant-Petitjean
- Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, AP-HP, Paris, France.,INSERM, Unité UMR-S 1144, Variabilité de Réponse aux Psychotropes, Université Paris Descartes-Paris Diderot, Paris, France.,Université Paris Diderot, Paris, France
| | - B Etain
- Groupe Henri Mondor-Albert Chenevier, Pôle de Psychiatrie, AP-HP, Créteil, France.,Unité 955, Equipe de Psychiatrie Translationnelle, IMRB, INSERM, Créteil, France.,Faculté de Médecine, IFR10, Université Paris Est Créteil, Créteil, France.,Fondation FondaMental, Créteil, France
| | - C Henry
- Groupe Henri Mondor-Albert Chenevier, Pôle de Psychiatrie, AP-HP, Créteil, France.,Unité 955, Equipe de Psychiatrie Translationnelle, IMRB, INSERM, Créteil, France.,Faculté de Médecine, IFR10, Université Paris Est Créteil, Créteil, France.,Fondation FondaMental, Créteil, France.,Unité Perception et Mémoire, Institut Pasteur, Paris, France
| | - J-P Kahn
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy et CHU de Nancy, Vandoeuvre les Nancy, France.,Université de Lorraine, Nancy, France
| | - J-M Azorin
- Fondation FondaMental, Créteil, France.,AP-HM, Pôle de psychiatrie, Hôpital Sainte Marguerite, Marseille, France
| | - M Leboyer
- Groupe Henri Mondor-Albert Chenevier, Pôle de Psychiatrie, AP-HP, Créteil, France.,Unité 955, Equipe de Psychiatrie Translationnelle, IMRB, INSERM, Créteil, France.,Faculté de Médecine, IFR10, Université Paris Est Créteil, Créteil, France.,Fondation FondaMental, Créteil, France
| | - F Bellivier
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Centre for Affective Disorders, IoPPN, Kings College, London, UK.,Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, AP-HP, Paris, France.,Fondation FondaMental, Créteil, France
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Abstract
Bipolar disorders are a group of psychiatric disorders with profound negative impact on affected patients. Even if their symptomatology has long been recognized, diagnostic criteria have changed over time and diagnosis often remains difficult. The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), issued in May 2013, comprises several changes regarding the diagnosis of bipolar disorders compared to the previous edition. Diagnostic categories and criteria for bipolar disorders show some concordance with the internationally also widely used Tenth Edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10). However, there are also major differences that are worth highlighting. The aim of the following text is to depict and discuss those.
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