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Adjunctive antidepressant treatment among 763 outpatients with bipolar disorder: Findings from the Bipolar CHOICE and LiTMUS trials.
Köhler-Forsberg, Ole; Sylvia, Louisa G; Fung, Vicki; Overhage, Lindsay; Thase, Michael; Calabrese, Joseph R; Deckersbach, Thilo; Tohen, Mauricio; Bowden, Charles L; McInnis, Melvin; Kocsis, James H; Friedman, Edward S; Ketter, Terence A; McElroy, Susan L; Shelton, Richard C; Ostacher, Michael J; Iosifescu, Dan V; Nierenberg, Andrew A.
Afiliación
  • Köhler-Forsberg O; Psychosis Research Unit and the Department of Affective Disorders, Aarhus University Psychiatry Hospital, Aarhus, Denmark.
  • Sylvia LG; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  • Fung V; Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
  • Overhage L; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
  • Thase M; Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
  • Calabrese JR; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
  • Deckersbach T; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
  • Tohen M; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts.
  • Bowden CL; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
  • McInnis M; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts.
  • Kocsis JH; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Friedman ES; Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio.
  • Ketter TA; Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
  • McElroy SL; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
  • Shelton RC; Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.
  • Ostacher MJ; Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas.
  • Iosifescu DV; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
  • Nierenberg AA; Department of Psychiatry, Weill Cornell Medical College, New York, New York.
Depress Anxiety ; 38(2): 114-123, 2021 02.
Article en En | MEDLINE | ID: mdl-32598093
BACKGROUND: Adjunctive antidepressants are frequently used for bipolar depression but their clinical efficacy has been studied in few trials and little is known about how co-occurring manic symptoms affect treatment response. METHODS: Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (N = 482) and Lithium Treatment Moderate-Dose Use Study (N = 281) were similar comparative effectiveness trials on outpatients with bipolar disorder comparing four different randomized treatment arms with adjunctive personalized guideline-based treatment for 24 weeks. Adjunctive antidepressant treatment could be used if clinically indicated and was assessed at every study visit. Adjusted mixed effects linear regression analyses compared users of antidepressants to nonusers overall and in different subcohorts. RESULTS: Of the 763 patients, 282 (37.0%) used antidepressant drugs during the study. Antidepressant users had less improvement compared to nonusers on the Clinical Global Impression Scale for Bipolar Disorder and on measures of depression. This was particularly true among patients with co-occurring manic symptoms. Exclusion of individuals begun on antidepressants late in the study (potentially due to overall worse response) resulted in no differences between users and nonusers. We found no differences in treatment effects on mania scales. CONCLUSIONS: In this large cohort of outpatients with bipolar disorder, clinically indicated and guideline-based adjunctive antidepressant treatment was not associated with lower depressive symptoms or higher mania symptoms. The treatment-by-indication confounding due to the nonrandomized design of the trials complicates causal interpretations, but no analyses indicated better treatment effects of adjunctive antidepressants.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trastorno Bipolar Tipo de estudio: Clinical_trials / Diagnostic_studies / Guideline Límite: Humans Idioma: En Revista: Depress Anxiety Asunto de la revista: PSIQUIATRIA Año: 2021 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trastorno Bipolar Tipo de estudio: Clinical_trials / Diagnostic_studies / Guideline Límite: Humans Idioma: En Revista: Depress Anxiety Asunto de la revista: PSIQUIATRIA Año: 2021 Tipo del documento: Article País de afiliación: Dinamarca Pais de publicación: Estados Unidos