In Bipolar Disorder, Antidepressant Monotherapy May Increase Mania Risk
the MPR take:
Few studies have evaluated if concomitant use of a mood stabilizer can protect against a switch to mania during antidepressant treatment in patients with bipolar disorder, despite antidepressants constituting 50% of all prescribed psychotropic medications for bipolar disorder. Using data from the Swedish Prescribed Drug Register, research in the American Journal of Psychiatry compared antidepressants as monotherapy with concomitant use of an antidepressant and mood stabilizer in patients with bipolar disorder. For patients with antidepressant monotherapy, the risk of mania significantly increased within the first three months of treatment but not between three and nine months; patients with concurrent treatment had no increased risk of mania in the first three months and a decreased risk thereafter. Rates of mania and the number of mania diagnoses were higher in the concomitant group, but the authors suggest that these patients may have had more severe bipolar disorder vs. the monotherapy group. Regardless, they advise caution to clinicians when prescribing antidepressant monotherapy to treat bipolar depressive episodes due to this increased risk of treatment-emergent mania.
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.
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