Abstract
Objective: to observe prospectively of switching rate of antidepressants in management of depressive episode. Methods: 190 patients with depressive episode treated by antidepressants were observed for 3 months and switching rate were assessed under “best natural therapy”. And switching criteria was following: 1) manic or hypomanic episode; or 2) promoting rapid cycling; or 3) YMRS ≥ 11 or irritability or aggravation in YMRS ≥ 3. 4) Psychiatrist thinks that the patients should be stopped to take antidepressants and should be placed by mood stabilizer or antipsychotics or their combination. Results: 1) 18 of 190 patients was found to switch in 3 month therapy. The switching rate was 9.47%. 2) 4 of 61 males was found and 14 females was found to switch, their switching rate was not significant (6.56%, 10.85%, X2 = 0.89, P > 0.05). 3) 10 of 170 unipolar depression and 8 of bipolar depression was found to switch, their switching rate was very significant (5.88%, 40%, X2 = 24.29, P 2 = 1.47, P > 0.05). 5) 7 of 54 patients token more two antidepressants and 11 patients token single antidepressant was found to switch, their switching rate was not significant (12.96%, 8.08%, X2 = 1.07, P > 0.05). 6) 7 of 38 patients with family history of mood disorder and 11 of patients without family history of mood disorder was found to switch, their switching rate was significant (18.4%, 7.23%, X2 = 4.43, P
Highlights
The concept of bipolar disorder has expanded from one in which there are major pathological variations in mood of a severe, extreme form,to one in which more subtle variation are found, which merger imperceptibly with “normal” mood variation
The nature of depressive episode determines the diversity of effects of antidepressant treatment variability, significant reaction differences often appear between unipolar depression and bipolar depression Therapy differences were apparent, so many depression treatment guidelines emphasize the distinction .Because some patients with depression present exciting performance in the role of antidepressants, the socalled “switching”, in which case there’s change we call turn to manic state, such as antidepressants cause mania or hypomania, so called BP-III patients, Bipolar III disorder refer to a more heterogeneous grouping of people who experience recurrent episodes of unipolar depression and show clinical features suggesting that they may go on to development a hypomanic or manic episode
Switching criteria: 1) to appear manic or hypomanic episode; or 2) to become quicker circulation of the originals; or 3) Young Mania Rating Scale ≥ 11 points or one of irritability and destruction attacks ≥3 points; or 4) therapists believe that the use of antidepressants should be discontinued antipsychotics or mood stabilizers or change their therapeutic methods
Summary
The concept of bipolar disorder has expanded from one in which there are major pathological variations in mood of a severe, extreme form ,to one in which more subtle variation are found, which merger imperceptibly with “normal” mood variation. Akiskal has note that ,when followed prospectively, many adults patients with antidepressant-associated hypomania are found to progress to bipolar states with spontaneous mania or hypomania months or years later. Whereas unipolar or bipolar depression, only depression episode, was companied mania, which was induced by antidepressants or naturally appearance, as has significant clinical role.
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