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首页> 外文期刊>The journal of clinical psychiatry >Self-reported history of manic/hypomanic switch associated with antidepressant use: data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).
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Self-reported history of manic/hypomanic switch associated with antidepressant use: data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).

机译：自我报告的与抗抑郁药使用有关的躁狂/低躁狂转换史：来自双相情感障碍系统治疗增强计划（STEP-BD）的数据。

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OBJECTIVE: Antidepressant safety and efficacy remain controversial for the treatment of bipolar depression. The present study utilized data from the National Institute of Mental Health Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) to examine the prevalence and clinical correlates of self-reported switch into mania/hypomania during antidepressant treatment. METHOD: Antidepressant treatment histories were examined from intake assessments for the first 500 subjects enrolled into the STEP-BD between November 1999 and November 2000. Affective switch was defined as a report of mania, hypomania, or mixed episodes within the first 12 weeks of having started an antidepressant. Demographic and clinical characteristics were compared for subjects with or without a history of acute switch during antidepressant treatment. RESULTS: Among the 338 subjects with prior antidepressant treatment and complete data on switch event outcomes, 44% reported at least 1 such occurrence. Patients with a shorter duration of illness (odds ratio [OR] = 1.02, 95% CI = 1.01 to 1.04) and a history of multiple antidepressant trials (OR = 1.73, 95% CI = 1.38 to 2.16) were more likely to report a history of switch than other patients. A significantly increased risk for affective polarity switch was identified in patients who had ever switched to mania/hypomania while taking tricyclic antidepressants (OR = 7.80, 95% CI = 1.56 to 28.9), serotonin reuptake inhibitors (OR = 3.73, 95% CI = 1.98 to 7.05), or bupropion (OR = 4.28, 95% CI = 1.72 to 10.6). Switch was less common during treatment with electroconvulsive therapy or monoamine oxidase inhibitors than other antidepressants. CONCLUSIONS: Antidepressants are associated with the potential risk for treatment-emergent mania or hypomania, particularly in bipolar patients with short illness duration, multiple past antidepressant trials, and past experience of switch with at least one antidepressant.
机译：目的：抗抑郁药的安全性和疗效在治疗双相抑郁症方面仍存在争议。本研究利用了来自美国国立卫生研究院精神疾病双相情感障碍系统治疗增强计划（STEP-BD）的数据，以研究抗抑郁治疗期间自我报告的转换为躁狂/低躁狂的患病率和临床相关性。方法：从1999年11月至2000年11月间入组STEP-BD的前500名受试者的摄入量评估中检查抗抑郁药治疗史。情感转换被定义为在患病后的前12周内出现躁狂，轻躁狂或混合发作的报告。开始服用抗抑郁药。比较了抗抑郁治疗期间有无急性病史的受试者的人口统计学和临床​​特征。结果：在338名接受过抗抑郁药治疗并获得完整的转换事件结局数据的受试者中，有44％的受试者至少报告了1次此类事件。病程较短的患者（优势比[OR] = 1.02，95％CI = 1.01至1.04），并且有多次抗抑郁试验的病史（OR = 1.73，95％CI = 1.38至2.16）更有可能报告病史比其他患者多。在服用三环类抗抑郁药（OR = 7.80，95％CI = 1.56至28.9），5-羟色胺再摄取抑制剂（OR = 3.73，95％CI =）时曾转为躁狂/低躁狂的患者中发现情感极性转换的风险显着增加。 1.98至7.05）或安非他酮（或= 4.28，95％CI = 1.72至10.6）。与其他抗抑郁药相比，在电惊厥疗法或单胺氧化酶抑制剂治疗期间，切换不常见。结论：抗抑郁药与出现治疗性躁狂或躁狂症的潜在风险有关，特别是在病程短，过去多次抗抑郁试验以及过去使用至少一种抗抑郁药进行换药经历的躁郁症患者中。

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