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Which patients with bipolar depression receive antidepressant augmentation? Results from an observational multicenter study

Published online by Cambridge University Press:  10 September 2021

Laura Musetti ,
Antonio Tundo ,
Erika Cambiali Open the ORCID record for Erika Cambiali [Opens in a new window] ,
Claudia Del Grande Open the ORCID record for Claudia Del Grande [Opens in a new window] ,
Rocco De Filippis ,
Caterina Franceschini ,
Luca Proietti ,
Sophia Betrò ,
Donatella Marazziti Open the ORCID record for Donatella Marazziti [Opens in a new window]  and
Liliana Dell’Osso
Laura Musetti
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Antonio Tundo
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Erika Cambiali*
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Claudia Del Grande
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Rocco De Filippis
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Caterina Franceschini
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Luca Proietti
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Sophia Betrò
Affiliation:
Istituto di Psicopatologia, Rome, Italy
Donatella Marazziti
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Liliana Dell’Osso
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
*
*Author for correspondence: Erika Cambiali, E-mail: [email protected]
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Abstract

Background

To identify demographic and clinical characteristics of bipolar depressed patients who require antidepressant (AD) augmentation, and to evaluate the short- and long-term effectiveness and safety of this therapeutic strategy.

Methods

One hundred twenty-two bipolar depressed patients were consecutively recruited, 71.7% of them received mood stabilizers (MS)/second-generation antipsychotics (SGA) with AD-augmentation and 28.3% did not. Patients were evaluated at baseline, and after 12 weeks and 15 months of treatment.

Results

The AD-augmentation was significantly higher in patients with bipolar II compared with bipolar I diagnosis. Patients with MS/SGA + AD had often a seasonal pattern, depressive polarity onset, depressive index episode with anxious features, a low number of previous psychotic and (hypo)manic episodes and of switch. They had a low irritable premorbid temperament, a low risk of suicide attempts, and a low number of manic symptoms at baseline. After 12 weeks of treatment, 82% of patients receiving ADs improved, 58% responded and 51% remitted, 3.8% had suicidal thoughts or projects, 6.1% had (hypo)manic switch, and 4.1% needed hospitalization. During the following 12 months, 92% of them remitted from index episode, 25.5% did not relapse, and 11% needed hospitalization. Although at the start advantaged, patients with AD-augmentation, compared with those without AD-augmentation, did not significantly differ on any outcome as well on adverse events in the short- and long-term treatment.

Conclusion

Our findings indicate that ADs, combined with MS and/or SGA, are short and long term effective and safe in a specific subgroup for bipolar depressed patients.

Keywords

Antidepressantsbipolar depressionlong-term treatmentshort-term treatmentefficacyswitch
Type
Original Research
Information
CNS Spectrums , Volume 27 , Issue 6 , December 2022 , pp. 731 - 739
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Institution where the research was conducted: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy Istituto di Psicopatologia, Rome, Italy

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