Research ArticleOriginal Article
Open Access

Clinical characteristics of antidepressant use and related manic switch in bipolar disorder

Tonguc D. Berkol, Yasin H. Balcioglu, Simge S. Kirlioglu, Zengibar Ozarslan, Serkan Islam and Ilker Ozyildirim
Neurosciences Journal January 2019, 24 (1) 45-52; DOI: https://doi.org/10.17712/nsj.2019.1.20180008

Article Figures & Data

Tables

  • Table 1

    Comparison of patients using ADs with those not using ADs.

    VariablesUsing ADs (n=123)Not using ADs (n=115)Z/χ2P-value
    n (%)
    Gender
     Female84 (68.29)74 (64.35)0.257a0.613
     Male39 (31.71)41 (35.65)
    +Education
     Primary25 (20.33)21 (18.26)2.486a0.500
     High school40 (32.52)48 (41.74)
     College54 (43.90)44 (38.26)
     None4 (3.25)2 (1.74)
    ++Marital status
     Married48 (39.02)55 (47.83)4.303a0.116
     Single51 (41.46)48 (41.74)
     Divorced24 (19.51)12 (10.43)
    Diagnosis
     Bipolar I111 (90.24)110 (95.65)1.869a0.171
     Bipolar II12 (9.76)5 (4.35)
    +++Age (SD)42.98 (11.8)39.17 (13.2)2.308b0.021*
    +++Age at onset of illness (SD)24.1 (8.0)23.1 (8.7)0.353b0.724
    +++Duration of illness (SD)18.46 (9.8)15.8 (8.5)2.226b0.026*

    • AD - antidepressants, NS - not significant (p>0.05), SD - standard deviation. Chi Square with Yates Correction,

    • ↵+ Fisher Exact Chi Square,

    • ↵++ Chi Square,

    • ↵+++ Mann Whitney U Test,

    • ↵a X2 value,

    • ↵b Z value.

    • ↵* p<0.05 - statistically significant

  • Table 2

    Comparison of the treatment characteristics between AD-m and AD-c groups.

    Treatment characteristicsAD-mAD-ct/Z/χ2P-value
    n (%)
    Patients (n)47/238 (19.74)76/238 (31.93)
    Manic switch
     Present30 (63.82)28 (36.84)7.440a0.006
     Absent17 (36.18)48 (63.16)
    +AD-type
     SSRI29 (61.7)48 (63.16)19.260a<0.001*
     TCA15 (31.9)5 (6.58)
     Venlafaxine0 (0)6 (7.89)
     Mirtazapine3 (6.4)17 (22.37)
    Combined agent
     Lithium-56 (73.7)--
     AC16 (21.1)
     AP4 (5.2)
    Mean dose (SD), (mg)
    ++++SSRI20.98 (5.3)22.87 (9.87)1.208b0.229
    +++TCA118.76 (78,65)116.55 (96.76)1.221c0.889
     Venlafaxine-93.7 (37.5)-
    +++Mirtazapine42.76 (12.65)38.17 (14.76)1.522c0.064
    ++++MED22.68 (10.87)22.12 (10.43)0.284b0.776
    ++++Age (SD)40.29 (11.98)42.56 (12.39)0.999b0.319
    +++Age at onset of disease (SD)25.13 (7.93)24.85 (7.9)0.998c0.841
    +++Duration of disease (SD)14.99 (8.15)19.87 (10.76)2.512c0.006*
    Mean duration (months)5.43 (6.79)12.65 (15.43)3.090c0.002*

    • Chi Square, Chi Square with Yates Correction,

    • ↵+ Fisher Exact Chi Square,++Chi Square,

    • ↵+++ Mann Whitney U test,

    • ↵++++ Student t Test, a Chi Square,

    • ↵b t value,

    • ↵c Z value. AD - antidepressant, SSRI - selective serotonin reuptake inhibitors, TCA - tricyclic antidepressants, AC - anticonvulsant, AP - antipsychotic, MED - mean equivalent dose, NS - not Significant (p>0.05).

    • ↵* p<0.05 statistically significant

  • Table 3

    Comparison of the patients with and without manic switch.

    Treatment characteristicsManic switch present (n=58)Manic switch absent (n=65)t/Z/χ2P-value
    n (%)
    +AD-type
     SSRI33 (42.85)44 (57.15)3.642a0.314
     TCA8 (40.00)12 (60.00)
     Venlafaxine2 (33.33)4 (66.67)
     Mirtazapine4 (20.0)16 (80.00)
    Duration of AD use
     ≤3 months9 (100)0 (0)12.083a0.006*
     3-6 months17 (44.7)21 (55.3)
     6-12 months13 (46.4)15 (53.6)
     >12 months19 (39.6)29 (60.4)
    +Combined agent
     Lithium21 (37.5)35 (62.5)2.422a0.302
     AC4 (25.0)12 (75.0)
     AP0 (0)4 (100)
    Diagnosis
     Bipolar I47 (42.35)64 (57.65)0.002a0.964
     Bipolar II5 (41.66)7 (58.34)
    Mean dose (SD), (mg)
    ++++SSRI22.98 (9.4)21.73 (8.76)0.600b0.550
    +++TCA103 (97.99)118 (103)0.439c0.330
    +++Venlafaxine75 (-)100 (43)1.095c0.273
    +++Mirtazapine32.86 (6.88)30.22 (18.76)0.276c0.782
    ++++MED22.68 (9)22.12 (12)0.290b0.772
    Mean duration (months)5.65 (6.34)13.12 (14.36)2.878c0.004*

    • Chi Square, Chi Square with Yates Correction,

    • ↵+ Fisher Exact Chi Square,++Chi Square,

    • ↵+++ Mann Whitney U test,

    • ↵++++ Student t Test,

    • ↵a X2 value,

    • ↵b t value,

    • ↵c Z value, AD - antidepressant, SSRI - selective serotonin reuptake inhibitors, TCA - tricyclic antidepressants, AC - anticonvulsant, AP - antipsychotic, MED - mean equivalent dose, NS - not Significant (p>0.05),

    • ↵* p<0.05 statistically significant.

  • Table 4

    The relationship between the durations of AD treatment and manic switch.

    Duration of useManic switch present (n=58)χ2P-value
    n (%)
    <6 months26 (44.8)4.3790.112
    6-12 months13 (22.4)
    >12 months19 (32.8)

    • Chi Square, AD - antidepressant

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