Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain.
J Psychiatr Res. 2021 May;137:319-327. doi: 10.1016/j.jpsychires.2021.02.060. Epub 2021 Feb 27.
High doses of antidepressants, particularly clomipramine and selective serotonin reuptake inhibitors (SSRIs), are the well-established treatment for obsessive-compulsive disorder (OCD), but manic/hypomanic episodes are potential adverse events associated with this treatment. A systematic literature review was performed on manic/hypomanic episodes in non-bipolar OCD patients. Clinical, sociodemographic and antidepressant characteristics during the manic/hypomanic switch were extracted using descriptive statistics. Data were obtained from 20 case reports and case series. Switching episodes mostly appeared in the first 12 weeks after antidepressant initiation and took place more frequently during SSRI use (mostly fluoxetine) in 64.3% of cases. Clomipramine and SSRI use differed non-significantly between the switching episodes that appeared during the first 12 weeks of antidepressant treatment and the episodes that appeared beyond 12 weeks. Switching episodes emerging before 12 weeks were associated with a lower defined daily dose of antidepressants than episodes emerging after 12 weeks. These findings suggest that there are two independent characteristics involved in manic/hypomanic switch in OCD: a) they appeared most frequently with SSRI use (fluoxetine) regardless of the time of it use, and b) episodes appeared in the first 12 weeks after SSRI or clomipramine initiation had a lower dose of antidepressant than episodes appeared after 12 weeks.
高剂量的抗抑郁药，特别是氯米帕明和选择性 5-羟色胺再摄取抑制剂（SSRIs），是治疗强迫症（OCD）的既定方法，但躁狂/轻躁狂发作是与这种治疗相关的潜在不良事件。对非双相 OCD 患者的躁狂/轻躁狂发作进行了系统的文献复习。使用描述性统计方法提取躁狂/轻躁狂转换期间的临床、社会人口统计学和抗抑郁药特征。数据来自 20 例病例报告和病例系列。转换发作大多出现在抗抑郁药开始后的前 12 周内，并且在 64.3%的情况下，SSRIs（主要是氟西汀）使用期间更频繁发生。在抗抑郁药治疗的前 12 周内和 12 周后出现的转换发作中，氯米帕明和 SSRIs 的使用无显著差异。在 12 周之前出现的转换发作与在 12 周之后出现的发作相比，抗抑郁药的定义日剂量较低。这些发现表明，OCD 中的躁狂/轻躁狂转换有两个独立的特征：a）它们最常与 SSRIs（氟西汀）的使用有关，无论其使用时间如何；b）SSRIs 或氯米帕明起始后 12 周内出现的发作比 12 周后出现的发作抗抑郁药剂量较低。
