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Published Online: 16 October 2023

Lower Switch Rate in Depressed Patients With Bipolar II Than Bipolar I Disorder Treated Adjunctively With Second-Generation Antidepressants

Lori L. Altshuler, M.D. [email protected], Trisha Suppes, M.D., Ph.D., David O. Black, Ph.D., Willem A. Nolen, M.D., Gabriele Leverich, M.S.W., Paul E. Keck, Jr., M.D., Mark A. Frye, M.D., Ralph Kupka, M.D., Susan L. McElroy, M.D., Heinz Grunze, M.D., Ph.D., Christina M.R. Kitchen, Ph.D., and Robert Post, M.D.Authors Info & Affiliations
Publication: FOCUS
Volume 21, Number 4
https://doi.org/10.1176/appi.focus.23021020
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Abstract

Objectives:

The authors compared the switch rate into hypomania/mania in depressed patients treated with second-generation antidepressants who had either bipolar I or bipolar II disorder.

Methods:

In a 10-week trial, 184 outpatients with bipolar depression (134 with bipolar I disorder, 48 with bipolar II disorder, two with bipolar disorder not otherwise specified) were treated with one of three antidepressants as an adjunct to mood stabilizers. The patients’ switch rates were assessed. Switch was defined as a Young Mania Rating Scale (YMRS) score >13 or a Clinical Global Impression (CGI) mania score ≥3 (mildly ill).

Results:

Depressed subjects with bipolar II disorder had a significantly lower acute switch rate into hypomania/mania when either YMRS or CGI criteria were used to define switch.

Conclusions:

These data suggest that depressed patients with bipolar II disorder are less vulnerable than those with bipolar I disorder to switch into hypomania/mania when treated with an antidepressant adjunctive to a mood stabilizer.
Reprinted from Am J Psychiatry 2006; 163:313–315, with permission from American Psychiatric Association Publishing. Copyright © 2006

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Information & Authors

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FOCUS
Volume 21 • Number 4 • Fall 2023
Pages: 430 - 433

History

Published in print: Fall 2023
Published online: 16 October 2023

Authors

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Lori L. Altshuler, M.D. [email protected]
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Trisha Suppes, M.D., Ph.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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David O. Black, Ph.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Willem A. Nolen, M.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Gabriele Leverich, M.S.W.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Paul E. Keck, Jr., M.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Mark A. Frye, M.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Ralph Kupka, M.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Susan L. McElroy, M.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Heinz Grunze, M.D., Ph.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Christina M.R. Kitchen, Ph.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Robert Post, M.D.
From the Department of Psychiatry and Biobehavioral Sciences and Department of Biostatistics, School of Public Health, University of California, Los Angeles; Department of Psychiatry, VA Greater Los Angeles Healthcare System, West Los Angeles Healthcare Center; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; Department of Psychiatry, University Medical Center Groningen, the Netherlands; Biological Psychiatry Branch, NIMH, NIH, Bethesda, Md.; Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, Mental Health Care Line and General Clinical Research Center, and Cincinnati VA Medical Center, Cincinnati; Altrech Institute for Mental Health Care, Utrecht, the Netherlands; and Department of Psychiatry, Ludwig-Maxmilians-Universitat Munich.
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Notes

Address correspondence and reprint requests to Dr. Altshuler, 300 UCLA Medical Plaza, Suite 1544, Box 957057, Los Angeles, CA 90095-7057; [email protected] (e-mail).

Funding Information

Supported by the Stanley Medical Research Institute and NIMH. Drug and matching placebo were supplied by GlaxoSmithKline, Pfizer U.S. Pharmaceuticals, and Wyeth Pharmaceuticals.

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