Depression

Only A Small Proportion Of Bipolar Disorder PatientsSwitch From Mania To Depression

Depression Switch Rate In Bipolar Mania ‘Low’

MedWire News: 24 September 2009

Only a small proportion of bipolar disorder patients switch from mania to depression, say European researchers in findings that suggest atypical antipsychotics may protect against the switch to depression.

Switching in mood polarity in bipolar disorder patients has been identified as a predictor for poor long-term outcomes. However, while the switch from depression to mania has received a great deal of attention, the risk for switching from mania to depression is poorly understood.

Eduard Vieta, from the University of Barcelona, and colleagues therefore examined data from the 2-year, prospective, observational European Mania in Bipolar Longitudinal Evaluation of Medication study on 2390 patients who took part in the maintenance phase of the investigation, which lasted for up to 24 months.

Depression Switch Rate In Bipolar Mania ‘Low’

MedWire News:  

Only a small proportion of bipolar disorder patients switch from mania to depression, say European researchers in findings that suggest atypical antipsychotics may protect against the switch to depression.

Switching in mood polarity in bipolar disorder patients has been identified as a predictor for poor long-term outcomes. However, while the switch from depression to mania has received a great deal of attention, the risk for switching from mania to depression is poorly understood.

Eduard Vieta, from the University of Barcelona, and colleagues therefore examined data from the 2-year, prospective, observational European Mania in Bipolar Longitudinal Evaluation of Medication study on 2390 patients who took part in the maintenance phase of the investigation, which lasted for up to 24 months.

The participants completed the Clinical Global Impression-Bipolar Disorder scale (CGI-BP), the Young Mania Rating Scale (YMRS), and the 5-item Hamilton Depression Rating Scale, the team reports in the Journal of Affective Disorders.

During the first 12 weeks of follow-up, 5.0% of the patients switched from mania to depression. Patients who switched to depression were, compared with non-switchers, significantly older at disease onset, presented less often with a mixed episode at baseline, had more depressive episodes, hospital admissions, and suicide attempts in the previous 12 months, had more substance abuse, had higher CGI-BP scores, and were more likely to be taking antidepressants and typical antipsychotics.

Cox analysis demonstrated that higher/faster switching to depression was significantly associated with more previous depressive episodes, at relative risks of 1.83, 2.58, and 3.29 for 1, 2, and ≥3 episodes, respectively, substance abuse other than alcohol or cannabis, at a relative risk of 2.39, greater CGI-BP severity, at a relative risk of 1.26, and benzodiazepine/other hypnotic use, at a relative risk of 1.69.

Factors associated with a significantly lower/slower rate of switching to depression were greater CGI-BP depression scores, YMRS severity, and atypical antipsychotic use, at relative risks of 0.71, 0.97, and 0.64, respectively.

The team concludes: “These findings, particularly the fact that atypical antipsychotics were associated with a lower switch risk, may have important implications for the treatment of patients with mania.”

Source:  MedWire   is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media.

© Current Medicine Group Ltd; 2009

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