University of Pisa, Pisa, Italy; Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
Barcelona Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
J Affect Disord. 2017 Sep;219:187-192. doi: 10.1016/j.jad.2017.05.035. Epub 2017 May 24.
The issue of antidepressant-induced mood switches to hypomania, mania, or mixed states within the course of mayor depressive disorder (MDD) has been a controversial topic. The present post-hoc analysis of the BRIDGE-II-MIX study focuses on the clinical features of patients with history of antidepressant-induced hypomania/mania (AIHM) in a large international sample of patients with major depressive episode (MDE).
2811 subjects with major depression were enrolled in this multicentre cross-sectional study. Current mixed symptoms, socio-demographic and other clinical variables were collected and compared among MDD-AIHM, MDD and BD patients.
475 patients out of 2811 had history of AIHM (16.90%). In the MDD-AIHM group, familiarity for BD and rates of atypical features and comorbid anxiety, eating and borderline personality disorders were similar to BD and significantly more frequent compared to MDD group. MDD-AIHM patients had more frequently more than 3 episodes and reported higher rates of treatment resistance, mood lability and irritability following treatment with antidepressants. Frequencies of depression with mixed features and (hypo)manic symptoms were similar in patients of MDD-AIHM and BD groups and significantly higher in both groups than in MDD.
there were widely varying rates of hospitalized patients across countries and the participating centres were not randomly selected.
Our results strongly support the DSM-5 inclusion of MDD patients with AIHM within the rubric of bipolar disorder. Differences with other MDD and BD were also observed suggesting the possibility that MDD-AIHM may represent a specific sub-population, particularly sensitive to exogenous input from antidepressants.
在重度抑郁症（MDD）病程中，抗抑郁药引起的心境向轻躁狂、躁狂或混合状态转变的问题一直存在争议。BRIDGE-II-MIX 研究的事后分析集中于具有抗抑郁药引起的轻躁狂/躁狂病史（AIHM）的大国际样本患者中的主要抑郁发作（MDE）患者的临床特征。
对 2811 例重度抑郁症患者进行了这项多中心横断面研究。收集并比较了 MDD-AIHM、MDD 和 BD 患者的当前混合症状、社会人口统计学和其他临床变量。
在 2811 例患者中，有 475 例（16.90%）有 AIHM 病史。在 MDD-AIHM 组中，BD 的熟悉程度和非典型特征以及共病焦虑症、饮食障碍和边缘型人格障碍的发生率与 BD 相似，与 MDD 组相比显著更高。MDD-AIHM 患者发作次数多于 3 次，且报告抗抑郁药治疗后情绪不稳定和易怒的发生率更高。MDD-AIHM 患者和 BD 患者的混合特征和（轻）躁狂症状的抑郁频率相似，且在两组中均显著高于 MDD。
各国住院患者的比例存在很大差异，参与的中心不是随机选择的。
我们的结果强烈支持 DSM-5 将具有 AIHM 的 MDD 患者纳入双相障碍范畴。与其他 MDD 和 BD 患者也存在差异，这表明 MDD-AIHM 可能代表一个特定的亚人群，对来自抗抑郁药的外源性输入特别敏感。
