Department of Psychiatry, Dokuz Eylul University, School of Medicine, Izmir, Turkey.
J Affect Disord. 2011 Nov;134(1-3):91-101. doi: 10.1016/j.jad.2011.06.019. Epub 2011 Jul 13.
Antidepressants are known to induce manic switch in patients with depression. Treatment-induced mania is not considered as bipolar disorder in DSM IV. The aim of this study was to assess whether clinical characteristics of patients with unipolar depression with a history of treatment-induced mania were similar to those of patients with bipolar disorder.
The study included 217 consecutive patients with DSM-IV mood disorders, diagnosed as: bipolar disorder type I (BP-I, n = 58) or type II (BP-II, n = 18) whose first episodes were depression, recurrent (unipolar) major depressive disorder with a history of antidepressant treatment-induced mania (switchers = sUD; n = 61) and without such an event (rUD; n = 80). First, the groups were compared with regard to clinical features and course specifiers using variance and chi-square analysis. Variables that differed significantly between the four groups were included in two-step cluster analysis to explore naturally occurring subgroups in all diagnoses. Subsequently, the relationship between the naturally occurring clusters and pre-defined DSM-IV diagnoses were investigated.
Two-step cluster analysis revealed two different naturally occurring groups. Higher severity of depressive episodes, with higher rate of melancholic features, higher number of hospitalization and suicide attempts were represented in one cluster where switchers (77%), bipolar I (94.8%) and II (83.3%) patients clustered together.
The findings of this study confirm that treatment-induced mania is a clinical phenomenon that belongs within the bipolar spectrum rather than a coincidental treatment complication, and that it should be placed under "bipolar disorders" in future classification systems.
The study includes the limitations of any naturalistic retrospective study.
抗抑郁药已知可诱发抑郁患者的躁狂发作。DSM-IV 中，治疗引起的躁狂不被视为双相障碍。本研究旨在评估有治疗引起的躁狂发作史的单相抑郁患者的临床特征是否与双相障碍患者相似。
该研究纳入了 217 例连续 DSM-IV 心境障碍患者，诊断为：单相（BP-I，n=58）或双相障碍（BP-II，n=18），首次发作均为抑郁，有抗抑郁药治疗引起的躁狂发作史（转换组=sUD；n=61）或无此事件（rUD；n=80）的复发性（单相）重性抑郁障碍。首先，使用方差和卡方分析比较各组的临床特征和病程特征。将四组之间差异有统计学意义的变量纳入两步聚类分析，以探索所有诊断中自然发生的亚组。随后，探讨自然发生的聚类与预定义的 DSM-IV 诊断之间的关系。
两步聚类分析显示出两个不同的自然发生的亚组。更严重的抑郁发作、更高的忧郁特征发生率、更多的住院次数和自杀企图出现在一个亚组中，转换组（77%）、双相 I 型（94.8%）和 II 型（83.3%）患者聚集在这个亚组中。
本研究的结果证实，治疗引起的躁狂是一种临床现象，属于双相谱内，而不是巧合的治疗并发症，在未来的分类系统中，它应该被归类于“双相障碍”。
本研究包括任何自然主义回顾性研究的局限性。
