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Why Do Clinicians Maintain Antidepressants in Some Patients With Acute Mania?

2010; Physicians Postgraduate Press, Inc.; Volume: 71; Issue: 08 Linguagem: Inglês

10.4088/jcp.09m05026gre

1555-2101

Adriane Ribeiro Rosa, Núria Cruz, Carolina Franco, Josep María Haro, Jordan Bertsch, Catherine Reed, Trond F. Aarre, José Sánchez‐Moreno, Eduard Vieta,

Schizophrenia research and treatment

Article AbstractObjective: Antidepressants are supposed to be withdrawn during a manic episode. The aim of this study was to analyze the characteristics of manic patients who received antidepressants during a manic phase in a large, naturalistic study. Method: The European Mania in Bipolar Longitudinal Evaluation of Medication was a 2-year prospective observational study of inpatients and outpatients with acute mania/mixed mania (DSM-IV or ICD-10 criteria) conducted in 14 European countries. Of 2,416 manic patients who continued into the maintenance phase of the study, 345 (14%) were taking an antidepressant and 2,071 (86%) were not taking an antidepressant at baseline, week 1, and/or week 2 postbaseline. Demographic and clinical variables were collected at baseline and each study visit up to 24 months. Outcome measures included the Clinical Global Impressions-Bipolar Disorder scale (CGI-BP overall, mania, and depression scores) at 12 weeks and 24 months, the 5-item Hamilton Depression Rating Scale (HDRS-5), and the Young Mania Rating Scale (YMRS) at 12 weeks only. The present study was conducted from December 2002 to June 2004. Results: More antidepressant maintenance use was seen in patients with mixed episodes (P†‰<†‰.001), rapid cyclers (P†‰<†‰.02), patients with more previous depressive episodes (P†‰<†‰.001), and patients with higher mean HDRS-5 score at baseline (P†‰<†‰.001)—specifically patients with anxiety (P†‰=†‰.013). Patients in the antidepressant group had significantly higher CGI-BP depression scores (P†‰<†‰.001) and a significantly higher rate of depression relapse (P†‰<†‰.001) at both 12 weeks and 24 months. Conclusions: Patients with mania receiving antidepressants are more likely to be outpatients with mixed episodes, anxiety, or rapid cycling and have a higher risk of depression relapse during follow-up.J Clin Psychiatry 2010;71(8):1000-1006Submitted: January 8, 2009; accepted March 6, 2009. Online ahead of print: March 23, 2010 (doi:10.4088/JCP.09m05026gre). Corresponding author: Eduard Vieta, MD, PhD, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, Villarroel 170, 08036-Barcelona, Spain (evieta@clinic.ub.es and evieta@mclean.harvard.edu).