Feng Lei, Wang Weiwei, Yin Can, Li Jing, Zhang Xinwei, Chang Xiaotian, Feng Zizhao, Van Zandt Mui, You Seng Chan, Seager Sarah, Reich Christian, Zhan Siyan, Sun Feng, Wang Gang
Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
Health Data Sci. 2025 Jun 3;5:0209. doi: 10.34133/hds.0209. eCollection 2025.
The use of antidepressants in the treatment of bipolar depression remains controversial due to concerns about their potential to induce mood polarity switches. This multinational observational study aims to examine the association between the use of antidepressants and the risk of hypomanic/manic switch among bipolar depressive patients. Four electronic health record databases (IQVIA Disease Analyzer Germany, IQVIA Disease Analyzer France, IQVIA US Hospital Charge Data Master, and Beijing Anding Hospital) and one administrative claims database (IQVIA US Open Claims) were analyzed, and the study period covered from January 2013 until December 2017. Treatment patterns of patients with bipolar depression were collected. The hazard ratio (HR) was calculated by comparing the incidence of hypomanic/manic switch in patients who received antidepressants (AD group) with that in those who did not receive any antidepressant (non-AD group) in 730 days after the date of the first diagnosis of bipolar depression. The analysis included a total of 122,843 patients from the 5 databases; 60.6% of them received antidepressants for bipolar depression. Across the 5 data sources, the mean age at index date ranged from 37.50 (15.72) to 52.10 (16.22) years. After controlling potential confounders by propensity score matching, the AD group's manic switch risk was not significantly higher than the non-AD group's (HR 1.04 [95% CI, 0.96 to 1.13]; = 0.989). Additionally, no statistically significant difference was observed between patients prescribed antimanic drugs and those who were not (HR 0.69 [95% CI, 0.38 to 1.25]; = 0.535). This study indicated that antidepressants were widely used in clinical settings for managing bipolar depression. The use of antidepressants was not associated with the risk of mania/hypomania switch when compared to non-antidepressants treatment. Therefore, antidepressants could be considered a treatment option for bipolar depression.
由于担心抗抑郁药可能诱发情绪极性转换，其在双相抑郁症治疗中的应用仍存在争议。这项跨国观察性研究旨在探讨双相抑郁患者使用抗抑郁药与轻躁狂/躁狂转换风险之间的关联。分析了四个电子健康记录数据库（IQVIA德国疾病分析器、IQVIA法国疾病分析器、IQVIA美国医院收费数据主库和北京安定医院）和一个行政索赔数据库（IQVIA美国公开索赔数据库），研究期间涵盖2013年1月至2017年12月。收集了双相抑郁症患者的治疗模式。通过比较双相抑郁症首次诊断日期后730天内接受抗抑郁药治疗的患者（抗抑郁药组）与未接受任何抗抑郁药治疗的患者（非抗抑郁药组）的轻躁狂/躁狂转换发生率，计算风险比（HR）。该分析共纳入了来自5个数据库的122843名患者；其中60.6%的患者因双相抑郁症接受了抗抑郁药治疗。在这5个数据源中，索引日期时的平均年龄在37.50（15.72）至52.10（16.22）岁之间。通过倾向得分匹配控制潜在混杂因素后，抗抑郁药组的躁狂转换风险并不显著高于非抗抑郁药组（HR 1.04 [95% CI，0.96至1.13]；P = 0.989）。此外，在开具抗躁狂药物的患者与未开具抗躁狂药物的患者之间未观察到统计学上的显著差异（HR 0.69 [95% CI，0.38至1.25]；P = 0.535）。这项研究表明，抗抑郁药在临床环境中被广泛用于治疗双相抑郁症。与非抗抑郁药治疗相比，使用抗抑郁药与躁狂/轻躁狂转换风险无关。因此，抗抑郁药可被视为双相抑郁症的一种治疗选择。
