. Intensity and frequency exposure to antidepressant and mood stabilizer in bipolar disorder treatment: Impact on stability

STREJILEVICH S.A., MARTINO D.J., IGOA A., MARENGO E., AIS E., FASSI G., GHAEMI N.S.

Munich, Alemania

Congreso; XXVI Collegium International Neuro-Psychopharmacologicum (CINP) Congress; 2008

Introduction: Antidepressants have limited efficacy in unipolar depression and less in bipolar depression.  This observational study examines the frequency of antidepressant (AD) and mood stabilizer (MS) use as correlates for mood instability and predictors of remission, as well as the potential for long term mood-destabilization following antidepressant treatment in bipolar depression.  Method: Patients with bipolar disorder with more than 12 months of prospective follow-up were included. Time spent ill during the follow up period was documented using modified life charting technique. Current and previous exposure to AD and MS were assessed.  Regression models were used to correct the results for severity of illness (such as age of onset and number of previous episodes of depression) and current treatment regimens.    Results: Treatment of previous episodes with AD was an independent predictor of changes of polarity and mixed symptoms. In contrast, years of exposure to MS was an independent predictor of time spent asymptomatic during follow up. The ratio between previous exposure to AD versus MS was associated with less weeks asymptomatic, more mixed symptomatology, and more changes of polarity. Conclusions: In this sample, antidepressant exposure was a major predictor of mood instability in the long-term outcome of bipolar disorder.  We also found that the ratio of previous exposure to antidepressant versus mood stabilizer use was associated with poor outcomes, suggesting that the harmful effect of antidepressants may be additive and related to how much they are used.