Antidepressant-associated diagnostic change from major depressive to bipolar disorder

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2024-06-24 DOI:10.1111/acps.13721

Leonardo Tondo, Alessandro Miola, Marco Pinna, Martina Contu, Ross J. Baldessarini

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Abstract

Background

Anticipating diagnostic change from major depressive (MDD) to bipolar disorder (BD) can support better prognosis and treatment, especially of depression but is challenging and reported research results are inconsistent. We therefore assessed clinical characteristics associated with diagnostic change from MDD to BD with antidepressant treatments.

Methods

We compared characteristics of 3212 initially MDD patients who became (hypo)manic during antidepressant treatment to those with stable MDD diagnoses as well as with cases of stable, spontaneous BD, using standard bivariate and multivariate statistics.

Results

Among MDD patients, 6.69% [CI: 5.85–7.61] changed to BD, mostly type II (BD2, 76.7%). BD-converters had higher rates of familial mood disorders (74.1% vs. 57.1%) or BD (33.7% vs. 21.0%) and 2.8-years younger onset than stable MDD patients. They also had more prior depressive recurrences/year, years-of-illness, mood-stabilizer treatment, divorces, fewer children, more suicide attempts and drug-abuse, and higher intake cyclothymia, YMRS and MDQ scores. Predictors independently associated with diagnostic conversion were: more familial BD, depressions/year, unemployment, cyclothymic temperament, suicidal ideation or acts, and fewer children. BD-converters vs. spontaneous BD cases had significantly more suicide attempts, BD2 diagnoses, and affected relatives. Converting to vs. spontaneous BD1 was associated with more ADHD, more suicidal ideation or behavior, MDI course, and younger onset; converting to vs. spontaneous BD2 had more episodes/year, unemployment, ADHD, substance abuse, suicidal ideation or attempts, and more relatives with BD.

Conclusions

Few (6.69%) initially MDD subjects converted to BD, most (76.7%) to BD2. Independent predictive associations with diagnostic change included: familial BD, more depressions/year, unemployment, cyclothymic temperament, suicidal behavior and fewer children. Notably, several characteristics were stronger among those changing to BD during antidepressant treatment vs. others with spontaneous BD.

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从重度抑郁症到双相情感障碍的抗抑郁相关诊断变化。

背景：预测从重度抑郁（MDD）到双相情感障碍（BD）的诊断变化有助于更好地预后和治疗，尤其是抑郁症的治疗，但这具有挑战性，而且报告的研究结果也不一致。因此，我们评估了与抗抑郁治疗后从重度抑郁症诊断为双相情感障碍相关的临床特征：我们采用标准的双变量和多变量统计方法，比较了 3212 例最初诊断为 MDD 但在抗抑郁治疗期间转为（低）躁狂的患者与诊断为 MDD 但病情稳定的患者以及病情稳定、自发转为 BD 的病例的特征：在 MDD 患者中，有 6.69% [CI：5.85-7.61] 转为 BD，其中大部分为 II 型（BD2，76.7%）。与稳定型 MDD 患者相比，BD 转换者的家族性情绪障碍（74.1% 对 57.1%）或 BD（33.7% 对 21.0%）发生率更高，发病年龄更小 2.8 岁。他们的抑郁复发次数/年、患病年数、情绪稳定剂治疗次数、离婚次数、子女人数、自杀未遂次数和药物滥用次数也更多，而且摄入的环状嗜铬细胞瘤、YMRS和MDQ评分也更高。与诊断转换独立相关的预测因素有：更多的家族性 BD、抑郁/年、失业、周期性气质、自杀意念或行为以及子女较少。与自发性 BD 病例相比，BD 转换者的自杀企图、BD2 诊断和受影响亲属的人数明显更多。转为BD1与自发BD1的患者有更多的ADHD、更多的自杀意念或行为、MDI病程以及更年轻的发病年龄；转为BD2与自发BD2的患者有更多的发作/年、失业、ADHD、药物滥用、自杀意念或企图以及更多的亲属患有BD：很少（6.69%）最初为 MDD 的受试者转为 BD，大多数（76.7%）转为 BD2。与诊断改变相关的独立预测因素包括：家族性 BD、每年抑郁次数较多、失业、周期性气质、自杀行为和子女较少。值得注意的是，与其他自发性 BD 患者相比，在抗抑郁治疗期间转为 BD 患者的几个特征更为明显。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.