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Despite Guidelines, Antidepressants Prescribed During Mania Episodes

Right or wrong, some clinicians are prescribing antidepressants for bipolar disorder patients experiencing episodes of mania, despite widely accepted guidelines that suggest otherwise.

Research now provides insight into the characteristics of those bipolar patients who are most likely to be prescribed the medication.

Led by Eduard Vieta of the University Clinic Hospital of Barcelona and a team of researchers, the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) provided the core data for the study. The initiative was a two-year study of inpatients and outpatients with acute mania or mixed mania (DSM-IV or ICD-10 criteria) conducted in 14 European countries.

Overall, the researchers analyzed data on 3,684 bipolar disorder patients with mania or mixed mania.

Findings revealed that of 2,416 manic patients who continued into the maintenance phase of the study, 14 percent were taking an antidepressant. Researchers noted that guidelines suggest that antidepressants be discontinued during a manic episode as they may exacerbate symptoms.

“The primary goal of treatment of mania is to restore behavioral control as quickly as possible in order to minimize danger to self and others and to limit the high economic, social, and personal costs of manic episodes,” explained Vieta and team.

Of the findings, researchers were able to identify that those with mixed episodes, anxiety or rapid cycling as well as patients presenting at a high risk for depression relapse were more likely to receive antidepressants than others with bipolar disorder. Most of the prescribed medications were for selective serotonin reuptake or serotonin-norepinephrine reuptake inhibitors.

Outcome measures used for the study included the Clinical Global Impressions-Bipolar Disorder scale—used for CGI-BP overall, mania, and depression scores—at 12 weeks and 24 months, the five-item Hamilton Depression Rating Scale (HDRS-5) and the Young Mania Rating Scale (YMRS) at 12 weeks only.

Specifically, patients with mixed episodes were 3.28 times more likely to be prescribed antidepressants than those with mania-only episodes. Patients with rapid cycling were 1.67 times more likely to be prescribed antidepressants than those without rapid cycling.

Other factors contributing to an increased likelihood for prescribed antidepressants during mania included high anxiety and a higher incidence of previous depressive episodes. Higher depression relapse rates were also evident at both 12 weeks and 24 months with patients prescribed antidepressants at 26.6 percent and 31.3 percent respectively, compared to 15.6 percent and 19.3 percent for those not.

Patients who were prescribed antidepressants also had significantly higher depression scores on the Clinical Global Impressions-Bipolar Disorder scale at both 12 weeks and 24 months than those who were not prescribed antidepressants.

The research team concluded that “these findings suggest that there is an unmet need to treat effectively the depressive burden within bipolar disorder, even during manic episodes, and that clinicians…use what they think might help, even against all the evidence.”

Source: MedWire News

Despite Guidelines, Antidepressants Prescribed During Mania Episodes

Selena Chavis

APA Reference
Chavis, S. (2015). Despite Guidelines, Antidepressants Prescribed During Mania Episodes. Psych Central. Retrieved on May 21, 2018, from https://psychcentral.com/news/2010/09/17/despite-guidelines-antidepressants-prescribed-during-mania-episodes/18393.html


Scientifically Reviewed
Last updated: 6 Oct 2015
Last reviewed: By John M. Grohol, Psy.D. on 6 Oct 2015
Published on PsychCentral.com. All rights reserved.