Top

Published in:

01-04-2003 | Review Article

Avoiding Drug-Induced Switching in Patients with Bipolar Depression

Authors: Dr Chantal Henry, Jacques Demotes-Mainard

Published in: Drug Safety | Issue 5/2003

Abstract

Antidepressant-induced switching is a major risk during the treatment of bipolar depression. Despite several clinical studies, questions remain regarding both the definition of these mood switches and the most appropriate therapeutic strategy to avoid this adverse effect.

This review will first briefly consider the current guidelines for the acute treatment of bipolar depression. We will then review the mechanisms of action of antidepressant and mood stabilisers, and the switches induced by various types of antidepressant treatments, or triggered by antidepressant withdrawal, as well as by atypical antipsychotics. We then will address the risk of mood switch according to the type of mood stabiliser used. The propensity to mood switches in bipolar patients is subject to individual differences. Therefore we will describe both the clinical and biological characteristics of patients prone to mood switches under antidepressant treatment. However, the clinical characteristics of the depressive syndrome may also be a key determinant for mood switches. Various data help identify the most appropriate drug management strategies for avoiding mood switches during the treatment of bipolar depression. Selective serotonin reuptake inhibitors appear to be the drugs of first-choice because of the low associated risk of mood switching. Antidepressants must be associated with a mood stabiliser and the most effective in the prevention of switches seems to be lithium. Whatever the mood stabiliser used, effective plasma levels must be ensured. The optimal duration of antidepressant treatment for bipolar depression is still an open issue — prolonged treatments after recovery may be unnecessary and may facilitate mood elation. Moreover, some mood episodes with mixed symptoms can be worsened by antidepressants pointing to the need for a better delineation of the categories of symptoms requiring antidepressant treatment. Finally, as a result of this review, we suggest some propositions to define drug-induced switches in bipolar patients, and to try to delineate which strategies should be recommended in clinical practice to reduce as far as possible the risk of mood switch during the treatment of bipolar depression.

Zornberg GL, Pope HG. Treatment of depression in bipolar disorder: new directions for research. J Clin Psychopharmacol 1993; 13(6): 397–408PubMedCrossRef

Prien RF, Rush AJ. National Institute of Mental Health Workshop report on the treatment of bipolar disorder. Biol Psychiatry 1996; 40: 215–20PubMedCrossRef

Ghaemi SN, Lenox MS, Baldessarini RJ. Effectiveness and safety of long-term antidepressant treatment in bipolar disorder. J Clin Psychiatry 2001; 62(7): 565–9PubMedCrossRef

Keller MB, Labori P, Coryell W, et al. Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. JAMA 1986; 255(3): 38–43

Goodwin FK, Jamison KF. Manic-depressive illness. New York: Oxford University Press, 1990

Frances AJ, Docherty JP, Kahn DA. The expert consensus guideline series: treatment of bipolar disorder. J Clin Psychiatry 1996, 57(Suppl 12A)

Frances AJ, Kahn DA, Carpenter D, et al. The expert consensus guidelines for treating depression in bipolar disorder. J Clin Psychiatry 1998; 59Suppl. 4: 73–9PubMed

American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorders. Am J Psychiatry 2002; 159 (4 Suppl.): 1–50

Alvarez JC, Gluk N, Arnulf I, et al. Decreased platelet serotonin transporteur sites and increased platelet inositol triphosphate levels in patients with unipolar depression: effects of clomipramine and fluoxetine. Clin Pharmacol Ther 1999; 66(6): 617–24PubMed

10.

Wang HY, Markowitz P, Levinson D, et al. Increased membrane-associated protein kinase C activity and translocation in blood platelets from bipolar affective disorder patients. J Psychiatry Res 1999; 33(2): 171–9CrossRef

11.

Chengappa KN, Levine J, Gershon S, et al. Inositol as an addon treatment for bipolar depression. Bipolar Disord 2000; 2(1): 47–55PubMedCrossRef

12.

Williams RSB, Cheng L, Mudge W, et al. A common mechanism of action for three mood-stabilizing drugs. Nature 2002; 417: 292–5PubMedCrossRef

13.

Manji HK, Zarate CA. Molecular and cellular mechanisms underlying mood stabilization in bipolar disorder: implications for the development of improved therapeutics. Mol Psychiatry 2002; 7(1): 1–7CrossRef

14.

Chang DM, Chen RW, Chalecka-Franaszek E, et al. Neuroprotective effects of lithium in cultured cells and animal models of diseases. Bipolar Disord 2002; 4(2): 129–36CrossRef

15.

Bunney WE. Psychopharmacology of the switch process in affective illness. In: Lipton M, Dimascio A, Killiam K, editors. Psychopharmacology: a generation of progress. New York: Raven Press, 1978: 1249–59

16.

Prien RF, Klett J, Caffey EM, et al. Lithium carbonate and imipramine in prevention of affective episodes. Arch Gen Psychiatry 1973; 29: 420–5PubMedCrossRef

17.

Prien RF, Kupfer DJ, Mansky PA, et al. Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Arch Gen Psychiatry 1984; 41: 1096–104PubMedCrossRef

18.

Akiskal HS, Djenderedjian AH, Rosenthal RH, et al. Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. Am J Psychiatry 1977; 134: 1227–3PubMed

19.

Wehr TA, Goodwin FK. Rapid cycling in manic-depressives induced by tricyclic antidepressants. Arch Gen Psychiatry 1979; 36: 555–9PubMedCrossRef

20.

Lewis JL, Winokur G. The induction of mania: a natural history study with controls. Arch Gen Psychiatry 1982; 39: 303–6PubMedCrossRef

21.

Altshuler LL, Post RM, Leverich GS, et al. Antidepressant-induced mania and cycle acceleration: a controversy revisited. Am J Psychiatry 1995; 152(8): 1130–8PubMed

22.

Peet M. Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants. Br J Psychiatry 1994; 164(4): 549–50PubMedCrossRef

23.

Boerlin HL, Gitlin MJ, Zoellner LA, et al. Bipolar depression and antidepressant-induced mania: a naturalistic study. J Clin Psychiatry 1998; 59: 374–9PubMedCrossRef

24.

Simpson SG, DePaulo JR. Fluoxetine treatment of bipolar II depression. J Clin Psychopharmacol 1991; 11(1): 52–4PubMedCrossRef

25.

Howland RH. Induction of mania with serotonin reuptake inhibitors. J Clin Psychopharmacol 1996; 16: 425–7PubMedCrossRef

26.

Cohn JB, Collins G, Ashbrook E, et al. A comparison of fluoxetine, imipramine and placebo in patients with bipolar depressive disorder. Int Clin Psychopharmacol 1989; 4(4): 313–22PubMedCrossRef

27.

Young ML. A double-blind placebo-controlled trial comparing the effect of paroxetine and imipramine in the treatment of bipolar depression. 2nd International Conference on Bipolar Disorders; 1997 Jun 19-21; Pittsburg (PA)

28.

Young LT, Joffe RT, Robb JC, et al. Double-blind comparison of addition of a second mood stabilizer versus an antidepressant to an initial mood stabilizer for treatment of patients with bipolar depression. Am J Psychiatry 2000; 157(1): 124–6PubMed

29.

Amsterdam JD, Garcia-Espana F, Fawcett J, et al. Efficacy and safety of fluoxetine in treating bipolar II major depressive episode. J Clin Psychopharmacol 1998; 18(6): 435–40PubMedCrossRef

30.

Henry C, Sorbara F, Lacoste J, et al. Antidepressant-induced mania in bipolar patients: identification of risk factors. J Clin Psychiatry 2001; 62: 249–55PubMedCrossRef

31.

American Psychiatric Association. DSM-IV. Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC: APA, 1994

32.

Sachs GS, Thase M. Bipolar disorder. Therapeutics: maintenance treatment. Biol Psychiatry 2000; 48: 573–81PubMedCrossRef

33.

Himmelhoch JM, Thase ME, Mallinger AG, et al. Tranylpromine versus imipramine in anergic bipolar depression. Am J Psychiatry 1991; 148(7): 910–6PubMed

34.

Angst J, Stable M. Efficacy of moclobemide in different patient groups: a meta-analysis of studies. Psychopharmacology 1992; 106: 109–13CrossRef

35.

Stoll AL, Mayer PV, Kolbrener M, et al. Antidepressant-associated mania: a controlled comparison with spontaneous mania. Am J Psychiatry 1994; 151: 1642–4645PubMed

36.

Silverstone T. Moclobemide vs imipramine in bipolar depression: a multicentre double-blind clinical trial. Acta Psychiatr Scand 2001; 104(2): 104–9PubMedCrossRef

37.

Sachs GS. Teatment-resistant bipolar depression. Psychiatr Clin North Am 1996; 19: 215–36PubMedCrossRef

38.

Beasley CM, Masica DN, Heiligenstein JH, et al. Possible monoamine oxidase inhibitor-serotonin reuptake inhibitor interaction: fluoxetine clinical data and preclinical findings. J Clin Psychopharmacol 1993; 13: 312–20PubMedCrossRef

39.

Shopsin B. Bupropion’s prophylactic efficacy in bipolar affective illness. J Clin Psychiatry 1983; 44: 163–9PubMed

40.

Haykel RF, Akiskal HS. Bupropion as a promosing approach to rapid cycling bipolar II patients. J Clin Psychiatry 1990; 51: 450–5

41.

Sachs GS, Lafer B, Stoll A, et al. A double-blind trial of bupropion versus desipramine for bipolar depression. J Clin Psychiatry 1994; 55(9): 391–3PubMed

42.

Fogelson DL, Bystritsky A, Pasnau R. Bupropion in the treatment of bipolar disorders: the same old story? J Clin Psychiatry 1992; 53: 443–6PubMed

43.

Grossman F, Potter WZ, Brown EA, et al. A double-blind study comparing idazoxan and bupropion in bipolar depressed patients. J Affect Disord 1999 Dec; 56(2-3): 237–43PubMedCrossRef

44.

Erfurth A, Michael N, Stadtland C, et al. Bupropion as add-on strategy in difficult-to-treat bipolar depressive patients. Neuropsychobiology 2002; 45Suppl. 1: 33–6PubMedCrossRef

45.

Thase ME, Sachs GS. Bipolar depression: pharmacotherapy and related therapeutic stategies. Biol Psychiatry 2000; 48: 558–72PubMedCrossRef

46.

Amsterdam J. Efficacy and safety of venlafaxine in the treatment of bipolar II major depressive episode. J Clin Psychopharmacol 1998 Oct; 18(5): 414–7PubMedCrossRef

47.

Stoner SC, William RJ, Worrel J, et al. Possible venlafaxine-induced mania. J Clin Psychopharmacol 1999; 19(2): 184–5PubMedCrossRef

48.

Shulman RB, Scheftner WA, Nayudu S. Venlafaxine-associated mania. J Clin Psychopharmacol 2001; 21(2): 239–41PubMedCrossRef

49.

Vieta E, Martinez-Aran A, Goikolea JM, et al. A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry 2002; 63–6: 508-12

50.

Sachs GS, Printz DJ, Kahn DA, et al. The Expert Consensus Guideline Series: medication treatment of bipolar disorder. Postgrad Med 2000 Apr; Special edition: 1–104

51.

Angst J, Angst K, Baruffol IK, et al. ECT-induced and drug-induced hypomania. Convuls Ther 1992; 8: 179–85PubMed

52.

Gabbay V, O’Dowd MA, Asnis GM. Combined antidepressant treatment: a risk factor for switching [letter]. J Clin Psychiatry 2002; 63(4): 367PubMedCrossRef

53.

Zubieta JK. Possible bupropion precipitation of mania and a mixed affective state. J Clin Psychopharmacol 1991; 11: 327–8PubMedCrossRef

54.

Goldstein TR, Frye MA, Denicoff KD, et al. Antidepressant discontinuation-related mania: critical prospective observation and theoretical implications in bipolar disorder. J Clin Psychiatry 1999; 60(8): 563–7PubMedCrossRef

55.

Mirin SM, Schatzberg AF, Creasey DE. Hypomania and mania after withdrawal of tricyclic antidepressants. Am J Psychiatry 1981; 138: 87–9PubMed

56.

Nelson JC, Schottenfield RS, Conrad ED. Hypomania after desipramine withdrawal. Am J Psychiatry 1983; 140: 624–5PubMed

57.

Dilsaver SC. Antidepressant withdrawal syndromes: phenomenology and pathophysiology. Acta Psychiatr Scand 1989; 79: 113–7PubMedCrossRef

58.

Henry C. SSRIs and induction of manic episode. J Clin Psychiatry 2002; 63(4): 367–8CrossRef

59.

Tran PV, Dellva MA, Toffelson GD, et al. Extrapyramidal symptoms and tolerability of olanzapine versus haloperidol in the acute treatment of schizophrenia. J Clin Psychiatry 1997; 58: 205–11PubMedCrossRef

60.

Miller CH, Mohr F, Umbrich D, et al. The prevalence of acute extrapyramidal signs and symptoms in patients treated with clozapine, risperdone, and conventional antipsychotics. J Clin Psychiatry 1998; 59: 69–75PubMedCrossRef

61.

Ghaemi SN, Sachs GS. Long term risperidone treatment in bipolar disorder: 6 month follow up. Int Clin Psychopharmacol 1997; 12: 333–8PubMedCrossRef

62.

Keck Jr PE, McElroy SL, Strakowski SM. Anticonvulsant and antipsychotics in the treatment of bipolar disorder. J Clin Psychiatry 1998; 59: 74–81PubMed

63.

Suppes T, Webb A, Paul B, et al. Clinical outcomes in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. Am J Psychiatry 1999; 156: 1164–9PubMed

64.

Tohen M, Sanger TM, McElroy SL, et al. Olanzapine versus placabo in the treatment of acute mania. Am J Psychiatry 1999; 156: 702–9PubMed

65.

Tohen M, Jacobs T, Grundy SL, et al. Efficacy of olanzapine in acute bipolar mania: a double-blind, placebo-controlled study. Arch Gen Psychiatry 2000; 57: 841–9PubMedCrossRef

66.

Aubry JM, Simon AE, Bertschy G. Possible induction of mania and hypomania by olanzapine or risperidone: a critical review of reported cases. J Clin Psychiatry 2000; 61(9): 649–55PubMedCrossRef

67.

Henry C, Demotes-Mainard J. Olanzapine-induced mania in bipolar disorders. J Psychiatry Neurosci 2002; 27(3): 200–1PubMed

68.

Lane HY, Lin YC, Chang WH. Mania induced by risperidone: dose related? J Clin Psychiatry 1998; 59: 85–6PubMedCrossRef

69.

Ichikawa J, Ishii H, Bonaccorso S, et al. 5-HT2A and D2 receptor blockade increases cortical DA release via 5HT1A receptor activation: a possible mechanism of atypical antipsychotic-induced cortical dopamine release. J Neurochem 2001; 76(5): 1521–31PubMedCrossRef

70.

Tohen M. Antidepressant effects of atypical antipsychotics. EU Bipolar Regional Neuroscience Conference; 2002 Sep 9-10; Geneva, Switzerland

71.

Pilla M, Perachon S, Sautel F, et al. Selective inhibition of cocaine-seeking behaviour by a partial dopamine D3 receptor agonist. Nature 1999; 400(6742): 371–5PubMedCrossRef

72.

Bellivier F, Henry C, Schurhof F, et al. Study of two polymorphisms of the serotonin transporter gene in unipolar and bipolar patients. Neurosci Lett 1998; 255(3): 243–6CrossRef

73.

Jann MW, Bitar AJ, Rao A. Lithium prophylaxis of tricyclic-antidepressant-induced mania in bipolar patients. Am J Psychiatry 1982; 139: 683–4PubMed

74.

Lewis JL, Winokur G. The induction of mania: a natural history study with controls. Arch Gen Psychiatry 1982; 39: 303–6PubMedCrossRef

75.

Rouillon F, Lejoyeux M, Filteau MJ. Unwanted effects of long term treatment. In: Montgomery SA, Rouillon FA, editors. Long-term treatment of depression. New York (NY): John Wiley & Sons, 1992: 81–111

76.

Bottlender R, Rudolf D, Stauss A, et al. Mood-stabilisers reduce the risk of developing antidepressant-induced maniform states in acute treatment of bipolar I depressed patients. J Affect Disord 2001; 63: 79–83PubMedCrossRef

77.

Davis LL, Kabel D, Patel D, et al. Valproate as an antidepressant in major depressive disorder. Psychopharmacol Bull 1996; 32: 647–52PubMed

78.

Post RM. Mood disorders: treatment of bipolar disorders. In Sadock BJ, Sadock VA, editors. Kaplan & Sadock’s comprehensive texbook of psychiatry. 7th ed. New York: William & Wilkins, 2000: 1385–1430

79.

Stoner SC, Worrel JA, Vlach D, et al. Retrospective analysis of serum valproate levels and need for an antidepressant drug. Pharmacotherapy 2001; 21(7): 850–4PubMedCrossRef

80.

Bowden CL, Calabrese JR, McElroy SL, et al. The efficacy of lamatrigine in rapid cycling and non-rapid cycling patients with bipolar disorder. Biol Psychiatry 1999; 45: 953–8PubMedCrossRef

81.

Calabrese JR, Bowden CL, Sachs GS, et al. A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group. J Clin Psychiatry 1999; 60: 79–88PubMedCrossRef

82.

Messenheimer J, Mullens EL, Giorgi L, et al. Safety review of adult clinical trial experience with lamotrigine. Drug Saf 1998; 18(4): 281–96PubMedCrossRef

83.

Henry C, Lacoste J, Bellivier F, et al. Temperament in bipolar illness: impact on prognosis. J Affect Disord 1999; 56: 103–8PubMedCrossRef

84.

MacQueen GM, Young LT, Marriott M, et al. Previous mood state predicts response and switch rates in patients with bipolar depression. Acta Psychiatr Scand 2002; 105: 414–8PubMedCrossRef

85.

Bottlender R, Rudolf D, Strauss A, et al. Are low basal serum levels of the thyroid stimulating hormone (b-TSH) a risk factor for switches into states of expansive syndromes (known in Germany as ‘manoform syndromes’ in bipolar I depression? Pharmacopsychiatry 2000; 33(2): 75–7PubMedCrossRef

86.

Mundo E, Walker M, Cate T, et al. The role of serotonin transporter protein gene in antidepressant-induced mania in bipolar disorder: preliminary findings. Arch Gen Psychiatry 2001; 58: 539–44PubMedCrossRef

87.

Bellivier F, Rousseva A, Henry C, et al. Antidepressant-induced mania, rapid cycling and the serotonin transporter gene polymorphism. Pharmacogenomics J. In press

88.

Koukopoulos A, Koukopoulos A. Bipolarity: beyond classic mania. Agitated depression as a mixed state and the problem of melancholia. Psychiatr Clin North Am 1999; 22: 547–62PubMedCrossRef

89.

Henry C. Why are some depressions worsened by antidepressants? [abstract]. The International Society for Affective Disorders; 2002 Mar 9-12; Taormina, Sicily

90.

Bottlender R, Sato T, Kleindienst N, et al. Mixed depressive features predict maniform switch during depression treatment in bipolar I disorder. J Affect Disord. In press

91.

Calabrese JR, Rapport DJ, Kimmel SE, et al. Controlled trials in bipolar I depression: focus on switch rates and efficacy. Eur Neuropsychopharmacol 1999; 9(4): 109–12CrossRef

92.

Nasrallah HA, Lyskowksi J, Schroeder D. TCA-induced mania: differences between switchers and nonswitchers. Biol Psychiatry 1982; 17(2): 271–4PubMed

93.

Post RM, Altshuler LL, Frye MA, et al. Rate of switch in bipolar patients prospectively treated with second-generation antidepressants as augmentation to mood stabilizers. Bipolar Disord 2001; 3(5): 259–65PubMedCrossRef

94.

Sachs GS, Thase M. Bipolar disorder therapeutics: maintenance treatment. Biol Psychiatry 2000; 48: 573–81PubMedCrossRef

95.

Moller HJ, Grunze H. Have some guidelines for the treatment of acute bipolar depression gone too far in the restriction of antidepressants? Eur Arch Psychiatry Clin Neurosci 2000; 250(2): 57–68PubMedCrossRef

Title: Avoiding Drug-Induced Switching in Patients with Bipolar Depression
Authors: Dr Chantal Henry
Jacques Demotes-Mainard
Publication date: 01-04-2003
Publisher: Springer International Publishing
Published in: Drug Safety / Issue 5/2003
Print ISSN: 0114-5916
Electronic ISSN: 1179-1942
DOI: https://doi.org/10.2165/00002018-200326050-00003

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Avoiding Drug-Induced Switching in Patients with Bipolar Depression

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2003

Risks and Benefits, Advantages and Disadvantages of Levonorgestrel-Releasing Contraceptive Implants

The authors’ reply

Lack of Awareness of Community-Acquired Adverse Drug Reactions Upon Hospital Admission

Violation of Homogeneity: A Methodologic Issue in the Use of Data Mining Tools

Application of Quantitative Signal Detection in the Dutch Spontaneous Reporting System for Adverse Drug Reactions