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  • Viktorin, AlexanderKarolinska Institutet (author)

The risk of switch to mania in patients with bipolar disorder during treatment with antidepressants alone and in combination with a mood stabilizer

  • Article/chapterEnglish2014

Publisher, publication year, extent ...

  • Stockholm :Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics,2014
  • electronicrdacarrier

Numbers

  • LIBRIS-ID:oai:openarchive.ki.se:10616/42159
  • ISSN:0002-9556
  • 10616/42159hdl
  • http://hdl.handle.net/10616/42159URI
  • https://doi.org/10.1176/appi.ajp.2014.13111501DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-54593URI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:129828845URI
  • https://gup.ub.gu.se/publication/209334URI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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 
  • 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.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Lichtenstein, PaulKarolinska Institutet (author)
  • Thase, Michael E (author)
  • Larsson, Henrik,1975-Karolinska Institutet(Swepub:oru)hiln (author)
  • Lundholm, CeciliaKarolinska Institutet (author)
  • Magnusson, Patrik K EKarolinska Institutet (author)
  • Landén, Mikael,1966Gothenburg University,Göteborgs universitet,Karolinska Institutet,Institutionen för neurovetenskap och fysiologi, sektionen för psykiatri och neurokemi,Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry(Swepub:gu)xlandt (author)
  • Karolinska InstitutetInstitutionen för neurovetenskap och fysiologi, sektionen för psykiatri och neurokemi (creator_code:org_t)
  • Karolinska Institutet
  • Karolinska Institutet

Related titles

  • In:The American Journal of PsychiatryStockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics0002-95560002-953X1535-7228

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