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A Journal on Psychiatry, Psychology and Psychopharmacology

Official Journal of the Italian Society of Social Psychiatry
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Minerva Psichiatrica 2013 March;54(1):83-92


language: Italian

Mixed mania and antidepressants: a clinical study on a sample of bipolar inpatients

Bertetto N., Rosso G., Blengino G., Bogetto F., Maina G

Servizio per i Disturbi Depressivi e d’Ansia, Dipartimento di Neuroscienze, Università di Torino, Torino, Italia


Aim: The aim of this study was to elucidate the relationship between mixed manic or hypomanic episodes and the use of antidepressants before their onset.
Methods: We enrolled a sample of 117 bipolar inpatients with a DSM-IV manic or hypomanic episode. Patients have been grouped according to the presence or absence of mixed features: mixed (hypo)mania was defined as a (hypo)manic episode with evidence of at least three depressive symptoms, according to criteria proposed by Elroy et al. A comparison between the two subgroups has been performed on socio-demographic and clinical characteristics and on psychopharmacologic treatments during the month before the onset of the symptomatology.
Results: Fifty-three percent of patients with mixed (hypo)mania and 25.5% patients with “pure” (hypo)mania assumed at least one antidepressant before the onset of the symptomatology (P=0.003). No statistically significant differences were found concerning mood stabilizers, antipsychotics and benzodiazepine. Further, patients with mixed (hypo)mania differ from patients with “pure” (hypo)manic episodes concerning the following domains: higher number of previous mixed episodes (1.15 vs. 0.33: P<0.001), higher rate of suicide attempt in current episode (6% vs. 0%: P=0.013) and of psychiatric lifetime comorbidity (66.7% vs. 29.4%: P<0.001), higher mean score at the CGI-BP (4.76 vs. 4.27, P=0.003) and lower mean score at the GAF (41.61 vs. 48.78, P=0.003).
Conclusion: Our data support the hypothesis that the use of antidepressants is related to the onset of mixed (hypo)manic episodes more than pure (hypo)manic episodes. This is a further evidence that the use of antidepressants should be limited as much as possible in bipolar disorder, especially in euthymic patient with previous mixed episodes or suicide attempts.

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