Antidepressant Use and Risk for Suicide Attempts in Bipolar Disorder

The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/2011; 72(12):1697; author reply 1697. DOI: 10.4088/JCP.11lr07372
Source: PubMed

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    • "Better understanding the relationship between BD and pain is also vital to control the potentially risky pharmacological side-effects when treating pain in bipolar depressed patients. For example, chronic pain is frequently treated with antidepressants [13,14] which are known to predispose BD patients to manic switches and to increase the risk of suicide, particularly when administered in the absence of a mood stabilizer [15,16]. Anticonvulsants have analgesic properties [17] and they are commonly prescribed to patients with chronic pain (i.e., neuropathic pain). "
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    ABSTRACT: Background While pain is frequently associated with unipolar depression, few studies have investigated the link between pain and bipolar depression. In the present study we estimated the prevalence and characteristics of pain among patients with bipolar depression treated by psychiatrists in their regular clinical practice. The study was designed to identify factors associated with the manifestation of pain in these patients. Methods Patients diagnosed with bipolar disorder (n=121) were selected to participate in a cross-sectional study in which DSM-IV-TR criteria were employed to identify depressive episodes. The patients were asked to describe any pain experienced during the study, and in the 6 weeks beforehand, by means of a Visual Analogical Scale (VAS). Results Over half of the bipolar depressed patients (51.2%, 95% CI: 41.9%–60.6%), and 2/3 of the female experienced concomitant pain. The pain was of moderate to severe intensity and prolonged duration, and it occurred at multiple sites, significantly limiting the patient’s everyday activities. The most important factors associated with the presence of pain were older age, sleep disorders and delayed diagnosis of bipolar disorder. Conclusions Chronic pain is common in bipolar depressed patients, and it is related to sleep disorders and delayed diagnosis of their disorder. More attention should be paid to study the presence of pain in bipolar depressed patients, in order to achieve more accurate diagnoses and to provide better treatment options.
    Full-text · Article · Apr 2013 · BMC Psychiatry
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    ABSTRACT: Depression is the most common mood state among individuals with Bipolar II (BP II) disorder. Indeed, much of the historical under-recognition of bipolar illness, and its misdiagnosis as unipolar disorder, stems from the overwhelming predominance and severity of depressive rather than manic (or hypomanic) symptoms. As described in Chapter 4, depression, far more than hypomania, accounts for the excess morbidity, functional disability and mortality from suicide in BP II patients. Because hypomanic periods are by definition non-disabling, with symptoms often ego-syntonic to patients, clinicians and patients alike often fail to distinguish BP II depression from unipolar depression. Differences in medication response, course, prognosis and outcome of unipolar depression vs. BP II disorder make this nosologic distinction far from academic. Thus, the optimal strategy for managing BP II depression assumes particular importance.
    No preview · Article · Jan 2012
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    ABSTRACT: Background: The treatment of patients with bipolar disorder (BD) is complex and psychiatrists often have to change treatment strategies. However, available data do not provide information about the most frequent patterns of treatment strategies prescribed in clinical practice and clinical/socio-demographic factors of drugs prescription. Objective: The aims of this study were: (1) to identify specific patterns of life-time treatment strategies in a representative sample of bipolar patients; (2) to assess consistency with guidelines recommendations; and (3) to investigate clinical/socio-demographic of patients. Methods: Six-hundred and four BD I and II out-patients were enrolled in a naturalistic cohort study at the Barcelona Bipolar Disorders Program, in a cross-sectional analysis. A principal component analysis was applied to group psychotropic drugs into fewer underlying clusters which represent patterns of treatment strategies more frequently adopted in the life-time naturalistic treatment of BD. Results: Three main factors corresponding to three main prescription patterns were identified, which explained about 60% of cases, namely, Factor 1 (21.1% of common variance), defined the "antimanic stabilisation package" including treatments with antimanic mechanism of action in predominantly manic-psychotic BD I patients; Factor 2 (20.4%), "antidepressive stabilisation package" that grouped predominantly depressed patients, and Factor 3 (16.4%) defined the "anti-bipolar II package", including antidepressant monotherapy in BD II patients with depressive predominant polarity, melancholic features and higher rates of suicide behaviours. Conclusions: This study identified three patterns of lifetime treatment strategies in three specific and different groups of naturalistically treated bipolar patients.
    Full-text · Article · Aug 2012 · European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology
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