Characteristics of bipolar disorder patients given antidepressants.

Evidence concerning efficacy of antidepressants in bipolar disorder remains inconsistent and inconclusive. As the appropriate clinical use for such patients remains unclear, we characterized outpatients with bipolar disorders who were or were not treated with antidepressants. Clinical data were collected systematically from consecutive outpatients in 11 participating Argentine mood-disorder clinics in 2007-2008. Diagnoses met DSM-IV criteria, supported by structured interviews based on the MINI-500. Of 338 outpatients diagnosed with bipolar I (45.0%), II (29.3%), or not-otherwise-specified (NOS) (25.7%) disorder, 128 (37.9%) received antidepressants. Subjects given antidepressants or not did not differ significantly by presence or severity of current depression or being suicidal but were more likely to be women. Bipolar I disorder patients were three times less likely than types II or NOS to receive an antidepressant, with or without a mood-stabilizer or antimanic agent. Despite inconclusive evidence for efficacy and safety of antidepressants in various phases of bipolar disorders, 37.9% of such patients were receiving an antidepressant in 11 Argentine outpatient clinics. Antidepressant treatment was least likely with type I disorder and was independent of current depression and not associated with more use of mood-stabilizing or antimanic agents.

Sensitivity and specificity of the mood disorder questionnaire and the bipolar spectrum diagnostic scale in Argentinean patients with mood disorders.

OBJECTIVE: To assess the sensitivity and specificity of two self-report instruments for detection of bipolarity in a sample of Argentinean patients. METHOD: Spanish versions of the MDQ and the BSDS were administered over four months at 11 sites in Argentina. Diagnoses were made using DSM-IV criteria and the MINI. The study sample consisted of patients diagnosed with Bipolar Disorder (BD) Types I, II, or NOS. BDNOS diagnoses were made using extended guidelines for bipolar spectrum symptoms. Unipolar patients were used as a control group. Of 493 patients screened, 354 completed evaluation by MDQ and MINI, and 363 by BSDS and MINI. RESULTS: Specificity of MDQ was 0.97 and BSDS was 0.81. MDQ sensitivity was 0.70 for bipolar type I (BD-I), 0.52 for bipolar II (BD-II) and 0.31 for bipolar not otherwise specified (BDNOS). BSDS sensitivities were 0.75, 0.70 and 0.51 respectively. LIMITATIONS: This study was performed in specialized outpatient settings and thus its results are not necessarily representative for other clinical settings. There was not a systematic evaluation of comorbid psychiatric disease or test-retest reliability. CONCLUSION: The local versions of the MDQ and the BSDS showed a sensitivity and specificity comparable to previous research. Our results indicate that in this sample, MDQ was more specific for BD and BSDS was more sensitive to detect BD-II and NOS. Since BD-I is more readily recognized than bipolar spectrum disorders, enhanced sensitivity of BSDS for soft bipolarity may be an advantage.

Tratamiento farmacológico de la depresión en pacientes bipolares / Pharmacological treatment of depression in bipolar patients

Se revisa el tratamiento de la depresión bipolar a la luz de la evidencia de la investigación y las estrategias de manejo propuestas. Se señala la relativa escasez de estudios controlados sobre el tratamiento de la depresión bipolar en comparación con la depresión unipolar. Se describe la eficacia y los efectos adversos de las diferentes drogas utilizadas en el tratamiento de la depresión bipolar incluyendo la de tipo psicótico poniendo énfasis en la prevención del viraje a manía a los ciclos rápidos y el efecto antidepresivo de los estabilizadores del humor principalmente litio. También se hace mención de la terapia electroconvulsiva en lo que se refiere a la depresión bipolar resistente. Se sugieren estrategias opcionales en el manejo de la depresión bipolar de acuerdo con el cuadro clínico y las dogas de elección incluyendo los estabilizadores del humor t los antipsicóticos típicos y atípicos para mejores resultados psicoterapéuticos.

Treatment of bipolar depression is reviewed in the light of research evidence and management strategied proposed. The relative scarcity of controlled studies on bipolar depression treatment in comparison to unipolar depression is pointed out. Efficacy and adverso effects of drugs indicated for bipolar depression including psychotic type is described which an emphases laid on the prevention of switching to mania or rapid cycling and, the antidepressant effect of mood stabilizars, mainly lithium. Electro convulsive therefore is also mentioned with regard to treatment-resistant bipolar depression. Optional strategies to cope with bipolar depression in accordance to clinical picture and drugs of choice including mood stabilizers, typical and atypical antipsychotics are suggested for best psychotherapeutical results.