Mania associated with antidepressant treatment: comprehensive meta‐analytic review

Tondo, Leonardo; Vázquez, Gustavo; Baldessarini, Ross J.

doi:10.1111/j.1600-0447.2009.01514.x

Cited by 218 publications

(217 citation statements)

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“…These findings are of fundamental importance to guide clinical management of patients with comorbidity between BD and OCD and suggest that physicians might avoid treating comorbid OC symptoms in BD with antidepressants. In fact, such an approach might worsen BD via SRI-induced mania/hypomania (7)(8)(9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the comorbidity may represent a severe subtype of BD, or a severe subtype of OCD, or two separate disease entities that cooccur by chance. The clinical question is whether, and how, to treat the comorbidity because the main treatment for one disease (serotonin reuptake inhibitors, SRIs, for OCD) (5,6) can worsen the other (antidepressants, like SRIs, can cause mania and/or more mood episodes in BD) (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic validity of comorbid bipolar disorder and obsessive–compulsive disorder: a systematic review

Amerio

Odone

Liapis

et al. 2014

Acta Psychiatr Scand

107

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Diagnostic validity of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review Amerio A, Odone A, Liapis CC, Ghaemi SN. Diagnostic validity of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review.Objective: At least 50% of bipolar disorder (BD) patients have an additional diagnosis, one of the most difficult to manage being obsessive-compulsive disorder (OCD). Defining the nosology of BD-OCD comorbidity has important clinical implications, given that treatments for OCD can worsen BD outcomes. Method: A systematic review was conducted on: i) BD-OCD comorbidity lifetime prevalence and ii) on standard diagnostic validators: phenomenology, course of illness, heredity, biological markers, and treatment response. Relevant papers published through March 30th 2013 were identified searching the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library. Results: Sixty-four articles met inclusion criteria. Lifetime comorbidity prevalence was 11-21% in BD patients and 6-10% in OCD patients. Compared to non-comorbid subjects, BD-OCD has a more episodic course of OC symptoms (up to 75% vs. 3%), typically with worsening during depression (78%) and improvement during mania/hypomania (64%), as well as a higher total mean number of depressive episodes (8.9 AE 4.2 vs. 4.1 AE 2.7) and perhaps more antidepressant-induced mania/hypomania (39% vs. 9%). Conclusion: In this first systematic review of BD-OCD comorbidity, it appears that OC symptoms are usually secondary to BD, rather than representing a separate disease. • The evidence so far on BD-OCD nosology-mainly based on the course of illness-supports the view that the majority of cases of comorbid BD-OCD are in fact cases of BD. OC symptoms usually are secondary manifestations of depressive or manic mood episodes.• BD-OCD patients may respond for both groups of symptoms with adequate doses of mood stabilizers and atypical antipsychotics. Because of the risk of worsening BD via SRI-induced mania/hypomania, antidepressants should only be used in a minority of refractory OCD. Considerations• Course of illness is the only diagnostic validator that clearly supports the OCD-BD construct as a subtype of BD. Findings on the phenomenology, heredity, biological markers, and treatment were fragmented and heterogeneous and mainly suggested increased severity of illness or functioning without helping us to answer the nosological question.• The use of retrospective assessment scales with unclear sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations may have biased results toward an overestimation of obsession's prevalence. In addition, small sample sizes, mainly from out-patients units, may have limited the generalizability of the results to a whole community.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic validity of comorbid bipolar disorder and obsessive–compulsive disorder: a systematic review

Amerio

Odone

Liapis

et al. 2014

Acta Psychiatr Scand

107

View full text Add to dashboard Cite

show abstract

“…According with the clinical observations that demonstrate the ineffectiveness of currently used mood stabilizers in preventing antidepressant-induced switch from depression to mania (Leverich et al, 2006;Tondo et al, 1981Tondo et al, , 2010 , lamotrigine (unpublished results) with imipramine fails to prevent the development of dopamine D2 receptor sensitization. Actually, carbamazepine seems to be effective, but its effect is due to the reduction of imipramine plasma levels due to the induction of the drug metabolism.…”

Section: Antidepressants Induce a "Bipolar-like Behaviour"mentioning

confidence: 99%

Memantine: A New Mood Stabilizer for Treatment-Resistant Bipolar Disorders

Serra¹,

Serra²,

Koukopoulos³

et al. 2012

Bipolar Disorder - A Portrait of a Complex Mood Disorder

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“…Indeed, Tondo et al [25] reported 12.5% of switch from depression to mania induced by antidepressants, and a great deal of evidence suggests that an increased dopaminergic transmission is associated with mania/hypomania [26][27][28][29][30].…”

mentioning

confidence: 99%

“…These findings indicated progressive and impressive improvement in the duration (from about 70% of total illness, 45% of depression, and 25% of mania/hypomania before memantine to less than 10% of total illness, 5% of depression, and 5% of mania hypomania after 3 years of memantine addition) and the severity of both affective phases of the disorder, with a greater improvement of depression than mania, and evidence of decreased severity of mania. Subjects with previous rapid-(≥ 4 episodes/year) or continuous-cycling were particularly improved.As for the possible mechanism of antimanic and mood stabilizing effect of memantine, we have demonstrated that chronic treatment with antidepressants sensitizes dopamine D2 receptors in the mesolimbic system, an effect that may contribute to their therapeutic action and may be responsible of their ability to induce switch from depression to mania in humans [11,12,[20][21][22][23][24].Indeed, Tondo et al [25] reported 12.5% of switch from depression to mania induced by antidepressants, and a great deal of evidence suggests that an increased dopaminergic transmission is associated with mania/hypomania [26][27][28][29][30].The sensitization of dopamine receptors (mania) is followed by a progressive desensitization of those receptors, associated with a depressivelike behavior assessed in the forced swimming test of depression [31][32][33].Thus, antidepressants induce a bipolar-like behavior, mimicking a cycle of the manic depressive illness (mania followed by depression).Memantine prevents the bipolar-like behavior in rats. Indeed it prevents both the sensitization of dopamine receptors (mania) induced by chronic treatment with imipramine, and the ensuing desensitization associated with the depressive behavior [33].…”

mentioning

confidence: 99%

The Urgent Need of New Mood-Stabilizers: The Promising Results of Memantine

Serra¹,

Demontis²,

Serra³

2016

Bipolar Disord

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The main aim of pharmacological treatment for Bipolar Disorder (BD) patients is the prevention of manic/hypomanic and depressive episodes by the administration of mood stabilizer drugs.Unfortunately, after several decades of its serendipitous discovery, lithium remains the only drug with consolidated evidence of moodstabilizing effect [1]. No important therapeutic innovations (i.e., a drug with major clinical benefit compared with existing drugs, according to the definition of Motola [2] have been introduced in the last 60 years.Some anticonvulsant medications and atypical antipsychotics are currently approved or used off-label as lithium alternative mood stabilizers. Anticonvulsants have been shown to be of limited efficacy both as a monotherapy and in combination with lithium [1,[3][4][5][6][7] and the mood stabilizing effect of atypical antipsychotics has been severely questioned [8,9]. Thus, the research and development of more effective moodstabilizers for the prophylaxis of bipolar patients resistant to lithium, is an urgent challenge of modern psychopharmacology.Indeed, even with currently available treatments, patients with BD remain unwell in 50% of their time, with about 75% of this time spent in depression [6].We have recently suggested that blockade of NMDA receptors by memantine, a drug with excellent safety and tolerability profile [10], could result in an antimanic and mood-stabilizing effect in treatmentresistant BD patients [11,12].Our group found suggestive evidence of the mood-stabilizing effect of memantine when added to stable, ongoing but inadequately effective standard treatments in 40 BD patients in two 6 and 12-month clinical trials [13,14].Memantine as a monotherapy also has been reported to show beneficial effects in few individual BD patients, including after discontinuation of lithium treatment [15][16][17][18].Finally, we reported the results of a three-year naturalistic study of adding memantine to 30 treatment-resistant bipolar patients [19]. In this trial, memantine achieves clinically meaningful long-term benefits, for both depressive and mania-like (mania, hypomania) morbidity, in outpatients who had proved resistant to standard treatments for more than 3 years, until memantine (20-30 mg/day) was added to otherwise stable regimens for another 3 years, during which patients improved progressively. Patients under memantine treatment showed a marked, statistically significant decrease of the illness morbidity (total, manic and depressive illness, on average-74.2%), the severity (CGI-BP; -63.1%), the duration (-56.3%) and the number of illness episodes (episodes/year; -55.8%). These findings indicated progressive and impressive improvement in the duration (from about 70% of total illness, 45% of depression, and 25% of mania/hypomania before memantine to less than 10% of total illness, 5% of depression, and 5% of mania hypomania after 3 years of memantine addition) and the severity of both affective phases of the disorder, with a greater improvement of depression than mania, and evi...

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Mania associated with antidepressant treatment: comprehensive meta‐analytic review

Abstract: Use of ADs in adults with BPD or MDD was highly prevalent and moderately increased the risk of mania overall, with little protection by mood stabilizers.

Cited by 218 publications

References 101 publications

Diagnostic validity of comorbid bipolar disorder and obsessive–compulsive disorder: a systematic review

Diagnostic validity of comorbid bipolar disorder and obsessive–compulsive disorder: a systematic review

Memantine: A New Mood Stabilizer for Treatment-Resistant Bipolar Disorders

The Urgent Need of New Mood-Stabilizers: The Promising Results of Memantine

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