Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
J Affect Disord. 2013 May 15;148(1):129-35. doi: 10.1016/j.jad.2012.10.033. Epub 2012 Dec 6.
Compare reported rates of mood-shifts from major depression to mania/hypomania/mixed-states during antidepressant (AD)-treatment and rates of diagnostic change from major depressive disorder (MDD) to bipolar disorder (BPD).
Searching computerized literature databases, followed by summary analyses.
In 51 reports of patients diagnosed with MDD and treated with an AD, the overall risk of mood-switching was 8.18% (7837/95,786) within 2.39 ± 2.99 years of treatment, or 3.42 (95% CI: 3.34-3.50) %/year. Risk was 2.6 (CI: 2.5-2.8) times greater with/without AD-treatment by meta-analysis of 10 controlled trials. Risk increased with time up to 24 months of treatment, with no secular change (1968-2012). Incidence rates were 4.5 (CI: 4.1-4.8)-times greater among juveniles than adults (5.62/1.26 %/year; p<0.0001). In 12 studies the overall rate of new BPD-diagnoses was 3.29% (1928/56,754) within 5.38 years (0.61 [0.58-0.64] %/year), or 5.6-times lower (3.42/0.61) than annualized rates of mood-switching.
AD-treatment was associated with new mania-like responses in 8.18% of patients diagnosed with unipolar MDD. Contributions to mood-switching due to unrecognized BPD versus mood-elevating pharmacological effects, as well as quantitative associations between switching and later diagnosis of BPD not associated with AD-treatment remain uncertain.
Rates and definitions of mood-switching with ADs varied greatly, exposure-times rarely were precisely defined, and there was little information on predictive associations between mood-switches and BPD-diagnosis.
比较抗抑郁药（AD）治疗期间从重度抑郁症到躁狂症/轻躁狂症/混合状态的情绪转变报告率，以及从重度抑郁症（MDD）到双相障碍（BPD）的诊断变化率。
检索计算机文献数据库，然后进行汇总分析。
在 51 项诊断为 MDD 并接受 AD 治疗的患者报告中，在治疗的 2.39±2.99 年内，整体情绪转变风险为 8.18%（7837/95786），即 3.42（95%CI：3.34-3.50）%/年。通过对 10 项对照试验的荟萃分析，AD 治疗的风险是未治疗的 2.6（CI：2.5-2.8）倍。随着时间的推移，风险增加至治疗 24 个月，没有时间变化（1968-2012）。在青少年中的发生率比成年人高 4.5（CI：4.1-4.8）倍（5.62/1.26%/年；p<0.0001）。在 12 项研究中，新的 BPD 诊断的总体发生率为 5.38 年内的 3.29%（1928/56754），即 0.61（0.58-0.64）%/年，或每年的发病率低 5.6 倍（3.42/0.61）。
在诊断为单相 MDD 的患者中，AD 治疗与新的类似躁狂症的反应相关，发生率为 8.18%。由于未识别的 BPD 导致情绪转变的贡献与情绪升高的药物作用，以及情绪转变与未接受 AD 治疗的 BPD 诊断之间的定量关联仍不确定。
AD 治疗时的情绪转变率和定义差异很大，暴露时间很少有精确的定义，而且关于情绪转变与 BPD 诊断之间的预测关联的信息很少。
