Which patients with bipolar depression receive antidepressant augmentation? Results from an observational multicenter study
- 10 September 2021
- journal article
- research article
- Published by Cambridge University Press (CUP) in CNS Spectrums
- Vol. 27 (6), 731-739
- https://doi.org/10.1017/s109285292100078x
Abstract
Background To identify demographic and clinical characteristics of bipolar depressed patients who require antidepressant (AD) augmentation, and to evaluate the short- and long-term effectiveness and safety of this therapeutic strategy. Methods One hundred twenty-two bipolar depressed patients were consecutively recruited, 71.7% of them received mood stabilizers (MS)/second-generation antipsychotics (SGA) with AD-augmentation and 28.3% did not. Patients were evaluated at baseline, and after 12 weeks and 15 months of treatment. Results The AD-augmentation was significantly higher in patients with bipolar II compared with bipolar I diagnosis. Patients with MS/SGA + AD had often a seasonal pattern, depressive polarity onset, depressive index episode with anxious features, a low number of previous psychotic and (hypo)manic episodes and of switch. They had a low irritable premorbid temperament, a low risk of suicide attempts, and a low number of manic symptoms at baseline. After 12 weeks of treatment, 82% of patients receiving ADs improved, 58% responded and 51% remitted, 3.8% had suicidal thoughts or projects, 6.1% had (hypo)manic switch, and 4.1% needed hospitalization. During the following 12 months, 92% of them remitted from index episode, 25.5% did not relapse, and 11% needed hospitalization. Although at the start advantaged, patients with AD-augmentation, compared with those without AD-augmentation, did not significantly differ on any outcome as well on adverse events in the short- and long-term treatment. Conclusion Our findings indicate that ADs, combined with MS and/or SGA, are short and long term effective and safe in a specific subgroup for bipolar depressed patients.Keywords
This publication has 56 references indexed in Scilit:
- Patterns of pharmacological maintenance treatment in a community mental health services bipolar disorder cohort study (SIN-DEPRES)International Journal of Neuropsychopharmacology, 2013
- Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013Bipolar Disorders, 2012
- Functional Impairment and Disability across Mood States in Bipolar DisorderValue in Health, 2010
- Antidepressants for the Acute Treatment of Bipolar DepressionPublished by Physicians Postgraduate Press, Inc ,2010
- Morbidity in 303 first‐episode bipolar I disorder patientsBipolar Disorders, 2010
- Antidepressant-Associated Mood Elevations in Bipolar II Disorder Compared With Bipolar I Disorder and Major Depressive DisorderPublished by Physicians Postgraduate Press, Inc ,2008
- Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey ReplicationArchives of General Psychiatry, 2007
- Effectiveness of Adjunctive Antidepressant Treatment for Bipolar DepressionThe New England Journal of Medicine, 2007
- A Rating Scale for Mania: Reliability, Validity and SensitivityThe British Journal of Psychiatry, 1978
- A RATING SCALE FOR DEPRESSIONJournal of Neurology, Neurosurgery & Psychiatry, 1960