Does tachyphylaxis occur after repeated antidepressant exposure in patients with Bipolar II major depressive episode?

Depression Research Unit, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-3309, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 08/2008; 115(1-2):234-40. DOI: 10.1016/j.jad.2008.07.007
Source: PubMed


Tachyphylaxis often refers to the loss of antidepressant efficacy during long-term treatment. However, it may also refer to the gradual loss of efficacy after repeated antidepressant exposures over time. The aim of this study was to examine the phenomenon of tachyphylaxis in patients with Bipolar II major depression treated with either venlafaxine or lithium. We hypothesized that a greater number of prior antidepressant exposures would result in a reduced response to venlafaxine, but not lithium, therapy.

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    • "A study on antidepressant-associated chronic irritable dysphoria (ACID) showed that it was significantly more common among bipolar I and II depressives who received antidepressants than among those who did not receive antidepressants, and the development of ACID (i.e., worsening of depression) was significantly related to past history of antidepressant-induced mood switches [14]. It is also known that bipolar spectrum and bipolar II depressives have frequently a loss of response to repeated trials of antidepressants (also called as tachyphyaxis) before developing chronic and severe AD-RD [8, 21]. "
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    ABSTRACT: The main goals of this chart-review study were to examine the rate of tachyphylaxis during treatment of dysthymia with antidepressants, to compare the incidence of tolerance during trials of selective serotonin reuptake inhibitors (SSRI) and non-SSRI and to give descriptive analysis of the cases of tachyphylaxis. The retrospective naturalistic chart review study included 52 cases of successfully treated (with different antidepressants) patients suffering from dysthymia. The overall number of the cases of tolerance to antidepressants were registered as well as the rate of these phenomena in the groups treated with SSRI and non-SSRI. The cases of tolerance/tachyphylaxis were observed in 12 patients (23% of patients) and in 13 trials (22.4% of trials). All cases of tolerance occurred during monotherapy. No cases of tachyphylaxis were observed in the non-SSRI group while in the SSRI group, tolerance at some stage of the treatment was detected in 41.9% of the successful cases (P < 0.001). During the treatment of dysthymia with antidepressants in the SSRI group, tachyphylaxis/tolerance might be observed in a relatively in high proportion of cases.
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