Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants.
TL;DR: The rate of treatment-emergent switch into mania has been calculated from all available clinical trial data on the selective serotonin re-uptake inhibitors (SSRIs) fluoxetine, fluvoxamine, paroxetines, and sertraline, relative to comparative groups treated with tricyclic antidepressants (TCAs) or placebo.
Abstract: The rate of treatment-emergent switch into mania has been calculated from all available clinical trial data on the selective serotonin re-uptake inhibitors (SSRIs) fluoxetine, fluvoxamine, paroxetine, and sertraline, relative to comparative groups treated with tricyclic antidepressants (TCAs) or placebo. In predominantly unipolar depressives, the rate of manic switch is less than 1% and differences between drugs and placebo are statistically but not clinically significant. In bipolar depressives, manic switch occurs substantially more often with TCAs (11.2%) than with SSRIs (3.7%) or placebo (4.2%).
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University of Oxford1, Northumberland, Tyne and Wear NHS Foundation Trust2, Imperial College London3, University of Melbourne4, Cognition and Brain Sciences Unit5, King's College London6, Fulbourn Hospital7, University Hospitals Birmingham NHS Foundation Trust8, University of California, Los Angeles9, University of Cambridge10, South London and Maudsley NHS Foundation Trust11
TL;DR: The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder, and recommend strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment.
Abstract: The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
989 citations
Cites background from "Induction of mania with selective s..."
...In a meta-analysis of patients without a previous history of mania, treatment with tricyclic antidepressants was twice as likely to result in a manic event as treatment with SSRIs or placebo (Peet, 1994)....
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University of British Columbia1, University of Toronto2, University of Michigan3, University of Minnesota4, McMaster University5, University of Western Ontario6, McGill University7, Dalhousie University8, University of Calgary9, Queen's University10, Kyushu University11, University of São Paulo12, Stanford University13, Case Western Reserve University14, University of Barcelona15, University of Sydney16, George Washington University17, Deakin University18
TL;DR: These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments.
Abstract: The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
950 citations
TL;DR: The present review did not consider cyclic, seasonal, irritable-dysphoric or otherwise impulse-ridden, intermittently explosive or agitated psychiatric conditions for which the bipolar connection is less established.
837 citations
TL;DR: Olanzapine is more effective than placebo, and combined olanzapine-fluoxetine isMore effective than olanZapine and placebo in the treatment of bipolar I depression without increased risk of developing manic symptoms.
Abstract: Background Despite the longer duration of the depressive phase in bipolar disorder and the frequent clinical use of antidepressants combined with antipsychotics or mood stabilizers, relatively few controlled studies have examined treatment strategies for bipolar depression. Objective To examine the use of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. Design Double-blind, 8-week, randomized controlled trial. Setting Eighty-four sites (inpatient and outpatient) in 13 countries. Patients A total of 833 randomized adults with bipolar I depression with a Montgomery-Asberg Depression Rating Scale (MADRS) score of at least 20. Intervention Patients were randomly assigned to receive placebo (n = 377); olanzapine, 5 to 20 mg/d (n = 370); or olanzapine-fluoxetine combination, 6 and 25, 6 and 50, or 12 and 50 mg/d (n = 86). Main Outcome Measure Changes in MADRS total scores using mixed-effects model repeated-measures analyses. Results During all 8 study weeks, the olanzapine and olanzapine-fluoxetine groups showed statistically significant improvement in depressive symptoms vs the placebo group ( P Conclusions Olanzapine is more effective than placebo, and combined olanzapine-fluoxetine is more effective than olanzapine and placebo in the treatment of bipolar I depression without increased risk of developing manic symptoms.
807 citations
Cites result from "Induction of mania with selective s..."
...Lastly, the rates of treatment-emergent mania reported in this study approximate those reported previously for placebo(11,35) and are lower than rates reported with tricyclic antidepressant use.(35) In terms of safety, the olanzapine adverse event profile was consistent with previously reported findings,(36,37) whereas the olanzapine-fluoxetine profile was similar to that of olanzapine, except for higher rates of nausea and diarrhea....
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01 Jan 2003
TL;DR: This guideline is more than 5 years old and has not yet been updated to Ensure that it reflects current knowledge and practice, and can no longer be assumed to be current.
Abstract: Each recommendation is identified as falling into one of three categories of endorsement, indicated by a bracketed Roman numeral following the statement. The three categories represent varying levels of clinical confidence regarding the recommendation: [I] Recommended with substantial clinical confidence. [II] Recommended with moderate clinical confidence. [III] May be recommended on the basis of individual circumstances.
657 citations
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TL;DR: There appear to be no placebo-controlled studies of switches into mania in bipolar patients during antidepressant treatment, and the available evidence suggests that some bipolar patients become manic, and a few experience rapid cycling, when they are treated with antidepressants.
Abstract: Several investigators have recently challenged the belief that antidepressants can precipitate mania or rapid cycling between mania and depression. With one exception, there appear to be no placebo-controlled studies of switches into mania in bipolar patients during antidepressant treatment. Patients most likely to switch into mania during antidepressant therapy have probably been excluded from maintenance treatment studies and are probably overrepresented in studies at special research facilities. On balance, the available evidence suggests that some bipolar patients become manic, and a few experience rapid cycling, when they are treated with antidepressants. The prevention of these responses will require further research on risk factors and on the antimanic efficacy of coadministered lithium or other mood stabilizers.
384 citations
"Induction of mania with selective s..." refers methods in this paper
...Wehr & Goodwin (1987) collated data from 12 double-blind placebo-controlledtrialsof treatmentwith TCAs and monoamine oxidase inhibitors....
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TL;DR: The rate of induction of mania by TCAs is not greater than what one would expect from the natural history of the illness itself, and lithium carbonate and neuroleptic treatment, as expected, significantly prevented the induction ofMania.
Abstract: • Previous reports have indicated that tricyclic antidepressants (TCAs) induce mania, but the studies suffer from lack of control groups. This study included 137 unipolar and 157 bipolar patients, all having two or more admissions to the same hospital. In many cases, the same patients were treated at one time with TCAs and at another time with no somatic therapy at all. Most patients who switched (20/23) were bipolar. Twenty-seven bipolar patients receiving no treatment had a 41% switch rate (rate/person). They had 32 admissions, and the rate of switch while receiving no treatment was 34% (rate/admission). Twenty-six patients receiving tricyclics had a 28% switch rate; for these, there were 30 admissions and the switch rate was 23%. Thus, it appears that the rate of induction of mania by TCAs is not greater than what one would expect from the natural history of the illness itself. Validity of these findings is attested to by the fact that lithium carbonate and neuroleptic treatment, as expected, significantly prevented the induction of mania.
145 citations
"Induction of mania with selective s..." refers background in this paper
...Lewis & Winokur (1982) looked at a retrospective casenote survey and found that switch into mania occurred during 23% of admissions when TCAs were used and in 34% of admissions when no treatment was given....
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TL;DR: Information is provided on how to identify the components of serotonin, a substance which acts as a “spatially aggregating force” in women to increase the likelihood of fertility and increase the chance of pregnancy.
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109 citations
TL;DR: A depressed woman with no history of bipolar illness developed a manic episode during treatment with fluoxetine, and this side effect appears to be a universal property of effective antidepressants, including this new, purely serotonergic agent.
Abstract: A depressed woman with no history of bipolar illness developed a manic episode during treatment with fluoxetine. This side effect appears to be a universal property of effective antidepressants, including this new, purely serotonergic agent.
33 citations
27 citations
"Induction of mania with selective s..." refers background in this paper
...Case reportsof manic reactionshave con tinuedtoappearintheliterature,notonlywithTCAs but also with the new drugs, such as selective serotonin re-uptake inhibitors (SSRI5) (Settle & Settle, 1984; Lebuegue, 1987;Hon & Preskorn, 1989; Nakra et al, 1989)....
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