患有情绪障碍的韩国青少年中抗抑郁药引发的情绪转换

Antidepressant-emergent mood switch in Korean adolescents with mood disorder.

作者信息

Park Kee Jeong, Shon Seunghyun, Lee Hyun-Jeong, Joo Yeonho, Youngstrom Eric A, Kim Hyo-Won

机构信息

*Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; and †Department of Psychology and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC.

出版信息

Clin Neuropharmacol. 2014 Nov-Dec;37(6):177-85. doi: 10.1097/WNF.0000000000000055.

DOI:10.1097/WNF.0000000000000055

PMID:25384075

Abstract

OBJECTIVES

The objectives of this study were to compare clinical characteristics of children and adolescents who experienced antidepressant-emergent mood switch (AEMS) and those who did not, and to investigate the predictors of AEMS in a clinical sample of Korean children and adolescents.

METHODS

Two psychiatrists retrospectively reviewed the medical records of 115 children and adolescents (age, 15.0 [2.0] years; 45 boys) that were prescribed antidepressants or lamotrigine for the treatment of a depressive episode of bipolar or depressive disorders from March 2010 to February 2012 at the Department of Psychiatry of Asan Medical Center. The diagnosis was reviewed and confirmed for each subject. Demographic information, clinical characteristics, family history, and psychiatric comorbidities were compared across subjects with and without AEMS.

RESULTS

Twelve subjects (10.4%) experienced AEMS. The latency to AEMS was 25.9 (20.9) days (range, 2-56 days; median, 18 days). Antidepressant-emergent mood switch was more frequent in subjects with bipolar disorder (BD) than in subjects with depressive disorder (P < 0.001) and in subjects with high socioeconomic status (P < 0.001). Previous suicidal attempt (P = 0.001), previous antidepressant exposure (P = 0.001), number of previous antidepressant exposures (P < 0.001), family history of other psychiatric disorder (P = 0.001), and concomitant antipsychotics (P = 0.006) were more common in subjects with AEMS than in subjects without AEMS. In multivariate logistic regression, diagnosis of BD (odds ratio [95% confidence interval], 15.94 [1.83-139.16]), concomitant antipsychotics (26.90 [2.43-297.38]), and family history of other psychiatric disorder (39.55 [3.05-512.22]) were significant predictors of AEMS.

CONCLUSIONS

Children and adolescents who experienced AEMS had distinct profiles of clinical characteristics. Antidepressant-emergent mood switch may be more associated with BD than with depressive disorder.

摘要

目的

本研究的目的是比较经历抗抑郁药诱发情绪转换（AEMS）的儿童和青少年与未经历者的临床特征，并调查韩国儿童和青少年临床样本中AEMS的预测因素。

方法

两位精神科医生回顾性审查了2010年3月至2012年2月在峨山医疗中心精神科因双相或抑郁障碍的抑郁发作而开具抗抑郁药或拉莫三嗪的115名儿童和青少年（年龄15.0[2.0]岁；45名男孩）的病历。对每个受试者的诊断进行了复查和确认。比较了有和没有AEMS的受试者的人口统计学信息、临床特征、家族史和精神科合并症。

结果

12名受试者（10.4%）经历了AEMS。AEMS的潜伏期为25.9（20.9）天（范围2 - 56天；中位数18天）。双相情感障碍（BD）受试者中抗抑郁药诱发情绪转换比抑郁障碍受试者更频繁（P < 0.001），且在社会经济地位高的受试者中更频繁（P < 0.001）。既往自杀未遂（P = 0.001）、既往抗抑郁药暴露史（P = 0.001）、既往抗抑郁药暴露次数（P < 0.001）、其他精神障碍家族史（P = 0.001）和同时使用抗精神病药（P = 0.006）在有AEMS的受试者中比没有AEMS的受试者更常见。在多因素逻辑回归中，BD诊断（比值比[95%置信区间]，15.94[1.83 - 139.16]）、同时使用抗精神病药（26.90[2.43 - 二十九七点三八]）和其他精神障碍家族史（39.55[3.05 - 五百一十二点二二]）是AEMS显著的预测因素。