Manic symptoms during depression warn of polarity switch

By Eleanor McDermid, Senior medwireNews Reporter

Concomitant manic symptoms and panic attacks are the strongest predictors of an impending switch to mania among patients with bipolar disorder who are currently depressed, shows analysis of the STEP-BD study.

The data from STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder) allowed the study authors to identify prospective predictors of switching from depression to mania.

Alessandro Serretti (University of Bologna, Italy) and co-researchers analysed 8915 depressive episodes among 1720 patients; 512 episodes ended in a switch to mania within 12 weeks, whereas 8403 did not.

After accounting for confounders, patients with probable or definite mood elevation over the last 4 to 7 days before the start of their current depressive episode had a significantly increased likelihood of switching to mania. The same was true for patients who, during their depressive episode, also had multiple manic symptoms of at least moderate severity and for those who experienced panic attacks.

Just 4.3% of depressive episodes in which none of these predictors were present were followed by a switch to mania, compared with 8.5% of those with at least one predictor and 24.6% of those with all three predictors.

Serretti and team note that manic symptoms can be overlooked in patients with prominent depressive symptoms. “Therefore, our results confirmed the clinical importance of carefully monitoring both depressive and manic symptoms during bipolar depressive episodes”, they write in the Journal of Psychiatric Research.

They also stress that physicians should investigate symptoms of anxiety and panic attacks.

Of note, antidepressants were not strongly associated with switch to mania, despite the known risks of antidepressant monotherapy in bipolar disorder patients.

Several past history variables were also associated with a switch to mania, with the strongest associations including younger age, previous suicide attempts and treatment history. “An impact of these variables should not be excluded especially in patients with absent or mild manic symptoms and no comorbid panic attacks”, says the team.

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