Depressed patients who become manic during antidepressant treatment appear likely to have other characteristics of bipolar disorder, and prudence requires that they be monitored closely if future trials of antidepressants are considered. Even a single occurrence of mood switching with antidepressant treatment can support a DSM-5 diagnosis of bipolar disorder but may not be sufficient to support indefinitely continued treatment aimed at mood stabilization.
Our findings also underscore the need for caution in starting antidepressant treatment in a new patient with depression. Several clinical factors may suggest increased risk of either drug-induced switching or spontaneous mania-like responses in depressed patients.
They include a family history of bipolar disorder or psychosis, onset before age 25, multiple recurrences of depression within several years, particular temperamental traits cyclothymic, hyperthymic, or irritable , previous postpartum disorder, psychomotor-retarded depression with hypersomnia and increased appetite, previous excessive activation with a mood-elevating drug, current agitated-dysphoric features, a possible comorbid substance use disorder, and treatment with a TCA or venlafaxine.
An additional clinical implication of switching from depression to mania in patients with bipolar disorder is that following a depression before mania course pattern versus mania before depression is associated with less favorable responses to mood-stabilizing agents. This predicts an excess of future depression episodes, with associated risks of substance abuse, disability, and excess mortality from suicide or, later, an intercurrent medical illness.
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The strongest association seemed to be for serotonin reuptake inhibitors, or SSRIs for short, and the dual action antidepressant venlafaxine, the analysis indicated. The researchers base their findings on the anonymised medical records of more than 21, adults in receipt of treatment for major unipolar depression between and at a large provider of inpatient and community mental healthcare in London.
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