A re‐examination of antidepressant treatment‐emergent mania in bipolar disorders: evidence of gender differences

Scott, Jan; Brichant‐Petitjean, Clara; Étain, Bruno; Henry, Chantal; Kahn, Jean‐Pierre; Azorin, Jean‐Michel; Leboyer, Marion; Bellivier, Frank

doi:10.1111/acps.12728

Cited by 18 publications

(17 citation statements)

References 41 publications

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“…AIM describes the observation that hypomanic and manic symptoms can emerge when bipolar disorder patients use antidepressants, particularly when they are not taking a concurrent mood stabilizing medication. However, most bipolar disorder patients do not develop AIM when exposed to antidepressants, and the current data suggest that the risk factors for AIM in men and women may differ [4]. Clinicians routinely screen for AIM when treating bipolar depression with antidepressants, but little is known about which demographic and clinical variables increase risk for AIM, and even less is known about gender-specific risk factors.…”

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confidence: 76%

“…Strikingly, in our sample, female sex was the only variable that emerged from regression modeling as a statistically significant risk factor for AIM. In another recent study, Scott et al [4] identified a number of factors that convey differential risk for AIM between men and women. They reported that male AIM patients were more likely to have an alcohol or substance use disorder, a history of suicide attempt(s), and a greater number of depressive episodes per year.…”

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confidence: 99%

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Sex differences in the incidence of antidepressant-induced mania (AIM) in bipolar disorders

Williams

McInnis

2018

Neuropsychopharmacol

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confidence: 76%

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confidence: 99%

Sex differences in the incidence of antidepressant-induced mania (AIM) in bipolar disorders

Williams

McInnis

2018

Neuropsychopharmacol

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“…58 The risk profiles for the development of an ADrelated TEM in BD differ significantly according to gender, with higher risk in females with a family history of BD-I and comorbid thyroid disorders, and in males with a history of suicide attempts and alcohol abuse. 59 So, even with the lack of published data, we can speculate that ADs should be used in comorbid BD/PMDD only during the acute depressive episodes of BD, in addiction to MS. Their use should be avoided during the manic states of BD and limited to refractory cases of PMDD during euthymic states.…”

Section: Antidepressants (Ads)mentioning

confidence: 99%

<p>Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges</p>

Sepede¹,

Brunetti²,

Giannantonio³

2020

NDT

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Bipolar disorder (BD) and premenstrual dysphoric disorder (PMDD) are two cyclic mood illnesses, sometimes presenting together. Their comorbidity appears to be linked to common biological mechanisms and usually results in more severity of mood symptoms and a poorer long-term outcome. Nevertheless, the management of comorbid PMDD/BD has been scarcely studied. Therefore, the aim of the present paper was to review the published literature on the treatment of comorbid PMDD/BD and to provide point-by-point hypotheses to address these complex clinical cases. We searched PubMed to identify the studies focused on the treatment and management of comorbid PMDD/BD using the following search words, alone and in combination: premenstrual dysphoric disorder, bipolar disorder, comorbid, treatment, management, pharmacotherapy, psychotherapy. The search was conducted on the 1st of June 2019 and yielded 55 records. Four papers met our inclusion/exclusion criteria and were therefore included in our qualitative synthesis. Integrating the few data pertaining to the treatment of comorbid PMDD/BD with the large amount of published data on the two conditions separately, we can suggest that the management of comorbid PMDD/BD needs as a first step to stabilize the bipolar symptoms by means of optimal dosages of mood stabilizers. Then, in euthymic BD patients, the PMDD symptoms could be treated with estroprogestins (first-line treatment). On the contrary, during acute phases of BD, antidepressants (for major depressive episodes) and atypical antipsychotics/hormonal modulators (for manic episodes) could be considered as promising add-on treatments to mood stabilizers. In case of resistant PMDD/BD symptoms, combined strategies should be taken into account, as well as alternative treatments, such as lifestyle changes. In conclusion, RCTs on comorbid PMDD/BD are still lacking. The management of this complex condition is therefore challenging and it requires a tailored treatment.

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“… 25 Two studies focused on evaluating the correlates and rates of switch using a strict definition of ATEM. 26 , 27 Study participants who had ATEM (n = 44) had different baseline Young Mania Rating Scale (YMRS) scores compared to those who had and had not responded to antidepressant treatment but did not have ATEM (n = 128). The baseline YMRS scores for participants with ATEM was 3.7 versus those without ATEM (1.8 to 2.5).…”

Section: Case 2: Gadmentioning

confidence: 99%

Treatment of anxiety disorders in patients with comorbid bipolar disorder

Ott

2018

Mental Health Clinician

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Anxiety disorders are the most prevalent comorbid diagnoses in patients with bipolar disorder (BD). A comorbid anxiety diagnosis can significantly impact the severity of bipolar symptoms, increase the risk of suicidality, and decrease psychosocial functioning and quality of life. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force published recommendations for treatment in 2012 suggesting that specific anticonvulsant mood stabilizers and second-generation antipsychotics are the medications of choice to treat these comorbidities. Serotonergic antidepressant medications are first-line medications for the treatment of most anxiety disorders; however, this can be problematic for a patient with BD. Antidepressant use in BD has been associated with a risk of manic switch as well as potential destabilization of mood. Mood stabilizer therapy should be established for patients with comorbid BD and an anxiety disorder before other medications are added to address the anxiety disorder. While benzodiazepine medications are recommended as third-line therapy in the CANMAT task force recommendations, their use should be avoided in patients with comorbid BD, posttraumatic stress disorder, and substance use disorders. The use of benzodiazepines should in general be avoided for all patients if possible, based upon current clinical research. Interpersonal, cognitive behavioral, and relaxation therapy are effective for the treatment of anxiety symptoms, especially emotional experiences, in patients who are euthymic.

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A re‐examination of antidepressant treatment‐emergent mania in bipolar disorders: evidence of gender differences

Abstract: Using stringent definitions of ATEM status to reduce the probability of inclusion of false-positive cases and false-negative controls, we identified for the first time that the risk profiles for the development of an ATEM differ significantly according to gender.

Cited by 18 publications

References 41 publications

Sex differences in the incidence of antidepressant-induced mania (AIM) in bipolar disorders

Sex differences in the incidence of antidepressant-induced mania (AIM) in bipolar disorders

<p>Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges</p>

Treatment of anxiety disorders in patients with comorbid bipolar disorder

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