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BMJ Open. 2015 Dec 14;5(12):e008341. doi: 10.1136/bmjopen-2015-008341.

Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study.

Author information

1
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
2
Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London, UK.
3
Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.

Abstract

OBJECTIVES:

To investigate the association between antidepressant therapy and the later onset of mania/bipolar disorder.

DESIGN:

Retrospective cohort study using an anonymised electronic health record case register.

SETTING:

South London and Maudsley National Health Service (NHS) Trust (SLaM), a large provider of inpatient and community mental healthcare in the UK.

PARTICIPANTS:

21,012 adults presenting to SLaM between 1 April 2006 and 31 March 2013 with unipolar depression.

EXPOSURE:

Prior antidepressant therapy recorded in electronic health records.

MAIN OUTCOME MEASURE:

Time to subsequent diagnosis of mania or bipolar disorder from date of diagnosis of unipolar depression, censored at 31 March 2014.

METHODS:

Multivariable Cox regression analysis with age and gender as covariates.

RESULTS:

The overall incidence rate of mania/bipolar disorder was 10.9 per 1000 person-years. The peak incidence of mania/bipolar disorder incidence was seen in patients aged between 26 and 35 years (12.3 per 1000 person-years). Prior antidepressant treatment was associated with an increased incidence of mania/bipolar disorder ranging from 13.1 to 19.1 per 1000 person-years. Multivariable analysis indicated a significant association with selective serotonin reuptake inhibitors (HR 1.34, 95% CI 1.18 to 1.52) and venlafaxine (1.35, 1.07 to 1.70).

CONCLUSIONS:

In people with unipolar depression, antidepressant treatment is associated with an increased risk of subsequent mania/bipolar disorder. These findings highlight the importance of considering risk factors for mania when treating people with depression.

KEYWORDS:

CRIS; SSRI; antidepressant induced mania; electronic health records; manic switch; venlafaxine

PMID:
26667012
PMCID:
PMC4679886
DOI:
10.1136/bmjopen-2015-008341
[Indexed for MEDLINE]
Free PMC Article

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