Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Italy.
Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, IDIBAPS CIBERSAM, Hospital Clínic de Barcelona, University of Barcelona, c/Villarroel, 170, 12-0, 08036, Barcelona, Catalonia, Spain; CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Barcelona, Spain.
Eur Neuropsychopharmacol. 2019 Jul;29(7):825-834. doi: 10.1016/j.euroneuro.2019.06.001. Epub 2019 Jun 18.
Resistance and worsening of depression in response to antidepressants (ADs) are major clinical challenges. In a large international sample of patients with major depressive disorder (MDD), we aim to explore the possible associations between different patterns of response to ADs and bipolarity. A total of 2811 individuals with a major depressive episode (MDE) were enrolled in the BRIDGE-II-MIX study. This post-hoc analysis included only 1329 (47%) patients suffering from MDD. Patients with (TRD-MDD, n = 404) and without (NTRD-MDD, n = 925) history of resistance to AD treatment and with (n = 184) and without (n = 1145) previous AD-induced irritability and mood lability (AIM) were compared using Chi-square, t-Student's test and logistic regression models. TRD-MDD patients resulted significantly associated with higher rates of AIM, psychotic features, history of suicide attempts, emotional lability and impulsivity, comorbid borderline personality disorder and polipharmacological treatment, compared to NTRD-MDD group. In comparison to NAIM-MDD patients, subjects in the AIM-MDD group showed significantly higher rates of first-degree family history for BD, previous TRD, atypical features, mixed features, psychiatric comorbidities, lifetime suicide attempts and lower age at first psychiatric symptoms. In addition, patients with AIM presented more often almost all the hypomanic symptoms evaluated in this study. Among these latter symptoms, logistic regressions showed that distractibility, impulsivity and hypersexuality were significantly associated with AIM-MDD. In conclusion, in MDD patients, a lifetime history of resistance and/or irritability/mood lability in response to ADs was associated with the presence of mixed features and a possible underlying bipolar diathesis.
抗抑郁药（ADs）治疗反应和恶化的抑郁是主要的临床挑战。在一项针对重度抑郁症（MDD）患者的大型国际样本中，我们旨在探讨 AD 反应不同模式与双相情感障碍之间的可能关联。共有 2811 名患有重度抑郁发作（MDE）的患者参加了 BRIDGE-II-MIX 研究。本事后分析仅包括 1329 名（47%）患有 MDD 的患者。比较了有（TRD-MDD，n=404）和无（NTRD-MDD，n=925）AD 治疗抵抗史以及有（n=184）和无（n=1145）AD 诱导的易激惹和情绪不稳定（AIM）的患者，采用卡方检验、t-Student 检验和逻辑回归模型。与 NTRD-MDD 组相比，TRD-MDD 患者的 AIM、精神病特征、自杀未遂史、情绪不稳定和冲动性、共患边缘型人格障碍和多药物治疗的发生率明显更高。与无 AIM-MDD 患者相比，AIM-MDD 组的一级亲属 BD 病史、既往 TRD、非典型特征、混合特征、精神共病、终生自杀未遂和首次精神症状出现年龄较低的患者比例明显更高。此外，AIM 患者更常出现本研究评估的几乎所有轻躁狂症状。在这些后者症状中，逻辑回归显示，注意力不集中、冲动和性欲亢进与 AIM-MDD 显著相关。总之，在 MDD 患者中，AD 治疗抵抗和/或易激惹/情绪不稳定的终生史与混合特征的存在和潜在的双相情感障碍倾向有关。
