Which patients with bipolar depression receive antidepressant augmentation? Results from an observational multicenter study. (10th December 2022)

• Record Type: Journal Article
• Authors: Musetti, Laura; Tundo, Antonio; Cambiali, Erika; Del Grande, Claudia; De Filippis, Rocco; Franceschini, Caterina; Proietti, Luca; Betrò, Sophia; Marazziti, Donatella; Dell'Osso, Liliana
• Is Part Of: CNS spectrums. Volume 27:Number 6(2022)
• Page Start: 731
• Page End: 739
• Publication Date: 2022-12-10
• Subjects: Antidepressants -- bipolar depression -- long-term treatment -- short-term treatment -- efficacy -- switch; Neuropsychiatry -- Periodicals; Nervous system -- Diseases -- Periodicals; Neurology -- Periodicals; 616.8005
• DOI: 10.1017/S109285292100078X
• Languages: English
• ISSNs: 1092-8529

Abstract

Abstract: Background: To identify demographic and clinical characteristics of bipolar depressed patients who require antidepressant (AD) augmentation, and to evaluate the short- and long-term effectiveness and safety of this therapeutic strategy. Methods: One hundred twenty-two bipolar depressed patients were consecutively recruited, 71.7% of them received mood stabilizers (MS)/second-generation antipsychotics (SGA) with AD-augmentation and 28.3% did not. Patients were evaluated at baseline, and after 12 weeks and 15 months of treatment. Results: The AD-augmentation was significantly higher in patients with bipolar II compared with bipolar I diagnosis. Patients with MS/SGA + AD had often a seasonal pattern, depressive polarity onset, depressive index episode with anxious features, a low number of previous psychotic and (hypo)manic episodes and of switch. They had a low irritable premorbid temperament, a low risk of suicide attempts, and a low number of manic symptoms at baseline. After 12 weeks of treatment, 82% of patients receiving ADs improved, 58% responded and 51% remitted, 3.8% had suicidal thoughts or projects, 6.1% had (hypo)manic switch, and 4.1% needed hospitalization. During the following 12 months, 92% of them remitted from index episode, 25.5% did not relapse, and 11% needed hospitalization. Although at the start advantaged, patients with AD-augmentation, compared with those without AD-augmentation, did not significantly differ on any outcome as well on adverse events in the short- and long-term treatment. Conclusion: Our findings indicate that ADs, combined with MS and/or SGA, are short and long term effective and safe in a specific subgroup for bipolar depressed patients.