Treatment-induced mania in bipolar depression: Identifying at-risk bipolar patients

2013 ◽  
Vol 28 (S2) ◽  
pp. 97-98
Author(s):  
C. Brichant-Petitjean
Keyword(s):  
At Risk ◽  
Negative Impact ◽  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Treatment Strategies ◽  
Small Sample ◽  
Consensus Definition ◽  
Increased Risk ◽  
Psychosocial Stability ◽  
Bipolar Patients

The treatment of bipolar depression is still an important challenge for clinicians and the number of evidence based options is limited. Antidepressants are the most frequently prescribed drugs for bipolar depression in clinical practice, even though the relative risks and benefits of using this treatment strategy has been strongly debated over the past 25 years. One of the reasons is that several placebo-controlled studies have shown that antidepressants could induce manic or hypomanic episodes and accelerate the rate of cycling, worsening the course of the illness by increasing the number of mood episodes over time. Antidepressant-Induced Manias (AIM) have been reported in a subgroup of about 25 to 30% of bipolar patients. There is an increased risk of mood switch with tricyclic antidepressants (TCAs) and serotonin and noradrenaline reuptake inhibitors (SNRIs). The occurrence of mania during antidepressant treatment is a crucial issue in the clinical management of Bipolar Disorder (BD) since it greatly interferes with the establishment of an optimal treatment for bipolar depression. It can have substantial negative impact on overall mood and psychosocial stability in patients receiving treatment for bipolar depression, possibly leading to treatment resistance. Therefore, the identification of clinical correlates associated with AIM is essential to better identify at-risk subgroups of patients and propose specific individualized treatment strategies for bipolar depression. No risk factors has been replicated so far, mostly because studies are characterized by small sample sizes and by the absence of a consensus definition of AIM, showing conflicting results. In this study, patients were classified according to a restrictive definition, similar to that used by Rousseva et al. (2003). An AIM− group (n = 135) was compared to AIM+ patients (n = 75) for clinical and sociodemographic factors as well as for psychological dimensions.

scholarly journals Characterising the severity of treatment resistance in unipolar and bipolar depression

BJPsych Open ◽  
2021 ◽  
Vol 7 (6) ◽  
Author(s):  
Rachael W. Taylor ◽  
Rebecca Strawbridge ◽  
Allan H. Young ◽  
Roland Zahn ◽  
Anthony J. Cleare
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Age At Onset ◽  
Treatment Resistance ◽  
Patient Characteristics ◽  
Patients At Risk ◽  
Resistant Depression ◽  
Depressive Episodes

Background Treatment-resistant depression (TRD) is classically defined according to the number of suboptimal antidepressant responses experienced, but multidimensional assessments of TRD are emerging and may confer some advantages. Patient characteristics have been identified as risk factors for TRD but may also be associated with TRD severity. The identification of individuals at risk of severe TRD would support appropriate prioritisation of intensive and specialist treatments. Aims To determine whether TRD risk factors are associated with TRD severity when assessed multidimensionally using the Maudsley Staging Method (MSM), and univariately as the number of antidepressant non-responses, across three cohorts of individuals with depression. Method Three cohorts of individuals without significant TRD, with established TRD and with severe TRD, were assessed (n = 528). Preselected characteristics were included in linear regressions to determine their association with each outcome. Results Participants with more severe TRD according to the MSM had a lower age at onset, fewer depressive episodes and more physical comorbidities. These associations were not consistent across cohorts. The number of episodes was associated with the number of antidepressant treatment failures, but the direction of association varied across the cohorts studied. Conclusions Several risk factors for TRD were associated with the severity of resistance according to the MSM. Fewer were associated with the raw number of inadequate antidepressant responses. Multidimensional definitions may be more useful for identifying patients at risk of severe TRD. The inconsistency of associations across cohorts has potential implications for the characterisation of TRD.

scholarly journals Bupropion Maintenance Treatment in Refractory Bipolar Depression: A Case Report

2017 ◽  
Vol 13 (1) ◽  
pp. 43-48
Author(s):  
Julia Dehning ◽  
Heinz Grunze ◽  
Armand Hausmann
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Maintenance Treatment ◽  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Mood Stabilizer ◽  
Obvious Benefit ◽  
Insufficient Response ◽  
Bipolar Patients

Background:The optimal duration of antidepressant treatment in bipolar depression appears to be controversial due to a lack of quality evidence, and guideline recommendations are either vague or contradictive. This is especially true for second line treatments such as bupropion that had not been subject to rigourous long term studies in Bipolar Disorder.Case presentation:We report the case of a 75 year old woman who presented with treatment refractory bipolar depression. Because of insufficient response to previous mood stabilizer treatment and refractory depressive symptoms, bupropion was added to venlafaxine and lamotrigine. From there onwards, the patient improved continuously without experiencing deterioration of depression or a switch into hypomania. Our patient being on antidepressants for allmost four years experienced an obvious benefit from longterm antidepressant administration.Conclusion:Noradrenergic/dopaminergic mechanisms of action may play a more prominent role in bipolar depression, and may still be underused as a therapeutic strategy in the acute phase as well as in long-term maintenance in at least a subgroup of bipolar patients. There is still a lack of evidence from RCTs, but this case report further supports antidepressant long-term continuation and the usefulness of a noradrenergic/dopaminergic antidepressant in the acute and maintenance treatment of bipolar disorder.

scholarly journals Partial remission, residual symptoms, and relapse in depression

2008 ◽  
Vol 10 (4) ◽  
pp. 431-437 ◽  
Keyword(s):  
Partial Remission ◽  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Good Evidence ◽  
Dysfunctional Attitudes ◽  
First Year ◽  
Tryptophan Depletion ◽  
Residual Symptoms ◽  
Symptoms Of Depression ◽  
Increased Risk

Partial remission from depression, with residual symptoms, is an important problem in depression. This paper reviews the frequency and features of this outcome, and its association with relapse. Residual symptoms occur in many depressed patients after acute treatment. They span the typical symptoms of depression, except those characteristic of severe disorders. Other persistent abnormalities include social dysfunction, dysfunctional attitudes, hypothalamic-pituitary-adrenal axis overactivity, shortened REM sleep latency, and mood lowering after tryptophan depletion. Associations of some of these with residual symptoms are not clear. There is growing evidence for similar residual symptoms in bipolar disorder, particularly bipolar depression. The most important consequence of residual symptoms is a much-increased risk of relapse, particularly in the first year. Residual symptoms are a strong indication for vigorous and longer than usual continuation of antidepressant treatment in order to prevent relapse. There is good evidence for the use of cognitive therapy as an adjunct.

scholarly journals Light Therapy for Patients With Bipolar Depression: Systematic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 65 (5) ◽  
pp. 290-300 ◽  
Author(s):  
Raymond W. Lam ◽  
Minnie Y. Teng ◽  
Young-Eun Jung ◽  
Vanessa C. Evans ◽  
John F. Gottlieb ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Response ◽  
Bipolar Depression ◽  
Meta Analysis ◽  
Light Therapy ◽  
Small Sample ◽  
Controlled Trials ◽  
Increased Risk ◽  
Significant Difference ◽  
Depressive Episodes

Objective Bipolar disorder (BD) is challenging to treat, and fewer treatments are available for depressive episodes compared to mania. Light therapy is an evidence-based nonpharmacological treatment for seasonal and nonseasonal major depression, but fewer studies have examined its efficacy for patients with BD. Hence, we reviewed the evidence for adjunctive light therapy as a treatment for bipolar depression. Methods We conducted a systematic review of databases from inception to June 30, 2019, for randomized, double-blind, placebo-controlled trials of light therapy in patients with BD (CRD42019128996). The primary outcome was change in clinician-rated depressive symptom score; secondary outcomes included clinical response, remission, acceptability, and treatment-emergent mood switches. We quantitatively pooled outcomes using meta-analysis with random-effects models. Results We identified seven trials representing 259 patients with BD. Light therapy was associated with a significant improvement in Hamilton Depression Rating Scale score (standardized mean difference = 0.43, 95% confidence interval [CI], 0.04 to 0.82, P = 0.03). There was also a significant difference in favor of light therapy for clinical response (odds ratio [ OR] = 2.32; 95% CI, 1.12 to 4.81; P = 0.024) but not for remission. There was no difference in affective switches between active light and control conditions ( OR = 1.30; 95% CI, 0.38 to 4.44; P = 0.67). Study limitations included different light treatment parameters, small sample sizes, short treatment durations, and variable quality across trials. Conclusion There is positive but nonconclusive evidence that adjunctive light therapy reduces symptoms of bipolar depression and increases clinical response. Light therapy is well tolerated with no increased risk of affective switch.

Switching, Induction of Rapid Cycling, and Increased Suicidality With Antidepressants in Bipolar Patients: Fact or Overinterpretation?

CNS Spectrums ◽  
2008 ◽  
Vol 13 (9) ◽  
pp. 790-795 ◽  
Author(s):  
Heinz C.R. Grunze
Keyword(s):  
Side Effects ◽  
Tricyclic Antidepressants ◽  
Bipolar Depression ◽  
Primary Treatment ◽  
Rapid Cycling ◽  
Ongoing Controversy ◽  
Increased Risk ◽  
Bipolar Patients ◽  
Depressive Syndromes ◽  
New Onset

AbstractAntidepressants constitute a central cornerstone in the treatment of depressive syndromes. In bipolar patients, however, there is an ongoing controversy about their usefulness for at least 3 decades. Early reports, mainly concerning tricyclic antidepressants, have repeatedly pointed toward unfavorable side effects on the course of the disorder, namely switching into (hypo)mania, induction of rapid cycling, and increased risk of suicide. Most evidence for both unfavorable and favorable effects has been deducted, thus far, from small studies with methodological flaws. More substantiated evidence only recently became available. From this it appears that, at least, the switch risk, and perhaps also the risk for rapid cycling and new-onset suicidality have been overinterpreted. At the same time, these new data raise doubt about the efficacy of anti-depressants as a primary-treatment choice in bipolar depression.

scholarly journals Antidepressant Treatment for Acute Bipolar Depression: An Update

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Ben H. Amit ◽  
Abraham Weizman
Keyword(s):  
Bipolar Depression ◽  
Antidepressant Treatment ◽  
Cochrane Collaboration ◽  
Unipolar Depression ◽  
Mood Stabilizers ◽  
The Past ◽  
First Line Therapy ◽  
Concurrent Use ◽  
The Subject ◽  
Bipolar Patients

While studies in the past have focused more on treatment of the manic phase of bipolar disorder (BD), recent findings demonstrate the depressive phase to be at least as debilitating. However, in contrast to unipolar depression, depression in bipolar patients exhibits a varying response to antidepressants, raising questions regarding their efficacy and tolerability.Methods. We conducted a MEDLINE and Cochrane Collaboration Library search for papers published between 2005 and 2011 on the subject of antidepressant treatment of bipolar depression. Sixty-eight articles were included in the present review.Results. While a few studies did advocate the use of antidepressants, most well-controlled studies failed to show a robust effect of antidepressants in bipolar depression, regardless of antidepressant class or bipolar subtype. There was no significant increase in the rate of manic/hypomanic switch, especially with concurrent use of mood stabilizers. Prescribing guidelines published in recent years rely more on atypical antipsychotics, especially quetiapine, as a first-line therapy.Conclusions. Antidepressants probably have no substantial role in acute bipolar depression. However, in light of conflicting results between studies, more well-designed trials are warranted.

scholarly journals Neuro-oncology management during the COVID-19 pandemic with a focus on WHO grades III and IV gliomas

2020 ◽  
Vol 22 (7) ◽  
pp. 928-935 ◽  
Author(s):  
Denise Bernhardt ◽  
Wolfgang Wick ◽  
Stephanie E Weiss ◽  
Arjun Sahgal ◽  
Simon S Lo ◽  
...  
Keyword(s):  
Consensus Statement ◽  
Negative Impact ◽  
Scale Up ◽  
Treatment Strategies ◽  
Mitigation Strategies ◽  
Interdisciplinary Treatment ◽  
Oncological Patients ◽  
Increased Risk ◽  
Practice Recommendation ◽  
International Experts

Abstract Background Because of the increased risk in cancer patients of developing complications caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), physicians have to balance the competing risks of the negative impact of the pandemic and the primary tumor disease. In this consensus statement, an international group of experts present mitigation strategies and treatment guidance for patients suffering from high grade gliomas (HGGs) during the coronavirus disease 2019 (COVID-19) pandemic. Methods Sixteen international experts in the treatment of HGG contributed to this consensus-based practice recommendation, including neuro-oncologists, neurosurgeons, radiation oncologists, and a medical physicist. Generally, treatment of neuro-oncological patients cannot be significantly delayed and initiating therapy should not be outweighed by COVID-19. We present detailed interdisciplinary treatment strategies for molecular subgroups in 2 pandemic scenarios, a scale-up phase and a crisis phase. Conclusion This practice recommendation presents a pragmatic framework and consensus-based mitigation strategies for the treatment of HGG patients during the SARS-CoV-2 pandemic.

A Silenced Population

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Kim Gryglewicz ◽  
Melanie Bozzay ◽  
Brittany Arthur-Jordon ◽  
Gabriela D. Romero ◽  
Melissa Witmeier ◽  
...  
Keyword(s):  
At Risk ◽  
Depressive Symptomatology ◽  
The United States ◽  
Future Research ◽  
At Risk Youth ◽  
Peer Relationship ◽  
Student Records ◽  
Cross Sectional ◽  
Increased Risk ◽  
Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

Dental Implant Placement in Patients with a History of Medications Related to Osteonecrosis of the Jaws: A Systematic Review

2020 ◽  
Author(s):  
Judd Sher ◽  
Kate Kirkham-Ali ◽  
Denny Luo ◽  
Catherine Miller ◽  
Dileep Sharma
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Drug Therapy ◽  
Dental Implant ◽  
Case Series ◽  
Cochrane Central Register ◽  
Bisphosphonate Treatment ◽  
Implant Placement ◽  
Increased Risk ◽  
History Of

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and OpenGrey databases were used to search for clinical studies (English only) to July 16, 2019. Study quality was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7542 studies. There were 28 studies reporting on bisphosphonates (5 cohort, 6 case control, and 17 case series) and one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies. Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ MRONJ. In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible. In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained prior to implant placement. The James Cook University College of Medicine and Dentistry Honours program and the Australian Dental Research Foundation Colin Cormie Grant were the primary sources of funding for this systematic review.

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