Antidepressant-Resistant Depression and Antidepressant-Associated Suicidal Behaviour: The Role of Underlying Bipolarity

Rihmer, Zoltán; Gonda, Xénia

doi:10.1155/2011/906462

Cited by 38 publications

(46 citation statements)

References 50 publications

(77 reference statements)

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“…These observations are at odds with the proposal that antidepressant treatment may increase suicidal risk in some young patients with unipolar depressive or anxiety disorders— possibly by inducing agitated-dysphoric states in those with unrecognized bipolar disorder, or as a direct toxic effect of the treatment (33, 44, 57, 99). …”

Section: Resultsmentioning

confidence: 97%

The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders

Pacchiarotti¹,

Bond²,

Baldessarini³

et al. 2013

AJP

Self Cite

634

427

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Objective The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. Method An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.

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Section: Resultsmentioning

confidence: 97%

The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders

Pacchiarotti¹,

Bond²,

Baldessarini³

et al. 2013

AJP

Self Cite

634

427

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“…14 Perhaps the biggest difference between MDEs with and without mixed features is treatment response to antidepressants. [15][16][17][18][19][20] That is, there is some evidence that certain antipsychotics may be effective for MDEs with mixed features, but no FDA approvals have been forthcoming yet (Table 3). 2 It is neurobiologically and psychopharmacologically plausible that mood stabilizers could be effective for MDEs with mixed features, but there is essentially no evidence for or against this theory (Table 4).…”

Section: -13mentioning

confidence: 99%

Mixed-up about how to diagnose and treat mixed features in major depressive episodes

Stahl¹

2017

CNS Spectr.

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The classical point of view—that major depressive episodes (MDEs), no matter what additional symptoms are present, should be treated first line with antidepressants—is now giving way to new a notion. The idea is that MDEs mixed with a few symptoms of mania/hypomania should be viewed very differently in terms of their natural history, clinical outcome, and treatment, and perhaps certain antipsychotics should be given as first-line treatment rather than antidepressant monotherapy.

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“…The low number of nonbipolar MDE included is probably because patients referred to ECT in Italy are usually characterized by severe, resistant, and long-lasting depression; and most of these patients had a bipolar disorder. [17][18][19] We included in this analysis patients with MDD and bipolar disorder (BD) to explore possible differences between the 2 types of MDE in ECT response. Study subjects were 18- When discordances regarding the diagnosis arose, all diagnostic information were reviewed for consensus agreement, and if necessary, patients were contacted for further clarification.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Remission in 208 Drug-Resistant Depressive Patients Treated With Electroconvulsive Therapy

Medda¹,

Mauri²,

Toni³

et al. 2014

The Journal of ECT

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Antidepressant-Resistant Depression and Antidepressant-Associated Suicidal Behaviour: The Role of Underlying Bipolarity

Cited by 38 publications

References 50 publications

The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders

The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders

Mixed-up about how to diagnose and treat mixed features in major depressive episodes

Predictors of Remission in 208 Drug-Resistant Depressive Patients Treated With Electroconvulsive Therapy

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