Skip to main content
×
×
Home

Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline

  • R. M. Post (a1), L. L. Altshuler (a2), G. S. Leverich (a1), M. A. Frye (a2), W A. Nolen (a3), R. W. Kupka (a4), T. Suppes (a5), S. McElroy (a6), P. E. Keck (a6), K. D. Denicoff (a7), H. Grunze (a8), J. Walden (a9), C. M. R. Kitchen (a10) and J. Mintz (a11)...
Abstract
Background

Few studies have examined the relative risks of switching into hypomania or mania associated with second-generation antidepressant drugs in bipolar depression.

Aims

To examine the relative acute effects of bupropion, sertraline and venlafaxine as adjuncts to mood stabilisers.

Method

In a 10-week trial, participants receiving out-patient treatment for bipolar disorder (stratified for rapid cycling) were randomly treated with a flexible dose of one of the antidepressants, or their respective matching placebos, as adjuncts to mood stabilisers.

Results

A total of 174 adults with bipolar disorder I, II or not otherwise specified, currently in the depressed phase, were included. All three antidepressants were associated with a similar range of acute response (49–53%) and remission (34–41%). There was a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline.

Conclusions

More caution appears indicated in the use of venlafaxine rather than bupropion or sertraline in the adjunctive treatment of bipolar depression, especially if there is a prior history of rapid cycling.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline
      Available formats
      ×
Copyright
Corresponding author
Dr Robert M. Post, Bldg 10, Room 3S239, 10 Center Drive MSC 1272, Bethesda, Maryland 20892-1272, USA. Tel: +1 301 496 4805; fax: +1 301 402 0052; email: postr@mail.nih.gov
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
Akiskal, H. S., Bourgeois, M. L., Angst, J., et al (2000) Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. Journal of Affective Disorders, 59 (suppl. 1), S5S30.
Altshuler, L., Kiriakos, L., Calcagno, J., et al (2001) The impact of antidepressant discontinuation versus antidepressant continuation on 1-year risk for relapse of bipolar depression: a retrospective chart review. Journal of Clinical Psychiatry, 62, 612616.
Altshuler, L., Suppes, T., Black, D., et al (2003) Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up. American Journal of Psychiatry, 160, 12521262.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Angst, J. & Sellaro, R. (2000) Historical perspectives and natural history of bipolar disorder. Biological Psychiatry, 48, 445457.
Ascher, J. A., Cole, J. O., Colin, J.-N., et al (1995) Bupropion: a review of its mechanism of antidepressant activity. Journal of Clinical Psychiatry, 56, 395401.
Cohn, J. B., Collins, G., Ashbrook, E., et al (1989) A comparison of fluoxetine, imipramine and placebo in patients with bipolar depressive disorder. International Clinical Psychopharmacology, 4, 313322.
Ghaemi, S. N., El-Mallakh, R. S., Baldassano, C. F., et al (2005) A randomized clinical trial of efficacy and safety of long-term antidepressant use in bipolar disorder. Bipolar Disorders, 7, 59.
Gijsman, H. J., Geddes, J. R., Rendell, J. M., et al (2004) Antidepressants for bipolar depression: a systematic review of randomized, controlled trials. American Journal of Psychiatry, 161, 15371547.
Goodwin, F. K. & Jamison, K. R. (1990) Manic–depressive Illness. New York: Oxford University Press.
Guille, C., Shriver, A., Demopulos, C., et al (1999) Bupropion vs. desipramine in the treatment of bipolar depression. Bipolar Disorder, 1, 33.
Himmelhoch, J. M., Thase, M. E., Mallinger, A. G., et al (1991) Tranylcypromine versus imipramine in anergic bipolar depression. American Journal of Psychiatry, 148, 910916.
Joffe, R. T., Macqueen, G. M., Marriott, M., et al (2005) One-year outcome with antidepressant – treatment of bipiolar depression. Acta Psychiatrica Scandinavica, 112, 105109.
Judd, L. L., Akiskal, H. S., Schettler, P. J., et al (2002) The long-term natural history of the weekly symptomatic status of bipolar disorder. Archives of General Psychiatry, 59, 530531.
Kupka, R. W., Luckenbaugh, D. A., Post, R. M., et al (2005) Comparison of rapid cycling and non-rapid cycling bipolar disorder based on prospective daily mood ratings in 539 outpatients. American Journal of Psychiatry, 162, 12731280.
Leverich, G. S., Nolen, W. A., Rush, A. J., et al (2001) The Stanley Foundation Bipolar Treatment Outcome Network. I. Longitudinal methodology. Journal of Affective Disorders, 67, 3344.
Leverich, G. S., Altshuler, L. A., Frye, M. A., et al (2006) Risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers. American Journal of Psychiatry, 163, 232239.
Montgomery, S. A., Feighner, J. P., Frazer, A., et al (1993) Venlafaxine: a new dimension in antidepressant pharmacotherapy. Journal of Clinical Psychiatry, 54, 119125.
Nemeroff, C. B., Evans, D. L., Gyulai, L., et al (2001) Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. American Journal of Psychiatry, 158, 906912.
Nolen, W. A., Luckenbaugh, D. A., Altshuler, L. L., et al (2004) Correlates of 1-year prospective outcome in bipolar disorder: results from the Stanley Foundation Bipolar Network. American Journal of Psychiatry, 161, 14471454.
Nomikos, G. G., Damsma, G., Wenkstern, D., et al (1989) Acute effects of bupropion on extracellular dopamine concentrations in rat striatum and nucleus accumbens studied by in vivo microdialysis. Neuropsychopharmacology, 2, 273279.
Nomikos, G. G., Damsma, G., Wenkstern, D., et al (1992) Effects of chronic bupropion on interstitial concentrations of dopamine in rat nucleus accumbens and striatum. Neuropsychopharmacology, 7, 714.
Post, R. M., Altshuler, L. L., Frye, M. A., et al (2001a) Rate of switch in bipolar patients prospectively treated with second-generation antidepressants as augmentation to mood stabilizers. Bipolar Disorder, 3, 259265.
Post, R. M., Nolen, W. A., Kupka, R. W., et al (2001b) The Stanley Foundation Bipolar Network: I. Rationale and methods. British Journal of Psychiatry, 178, 169176.
Post, R. M., Denicoff, K. D., Leverich, G. S., et al (2003a) Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH Life Chart Method. Journal of Clinical Psychiatry, 64, 680690.
Post, R. M., Leverich, G. S., Nolen, W. A., et al (2003b) A reevaluation of the role of antidepressants in the treatment of bipolar depression: data from the Stanley Bipolar Treatment Network. Bipolar Disorder, 5, 396406.
Post, R. M., Speer, A. M. & Leverich, G. S. (2003c) Bipolar illness: which critical treatment issues need studying? Clinical Approaches in Bipolar Disorders, 2, 2430.
Rush, A. J., Giles, D. E., Schlesser, M. A., et al (1986) The inventory for depressive symptomatology (IDS): preliminary findings. Psychiatry Research, 18, 6587.
Rush, A. J., Gullion, C. M., Basco, M. R., et al (1996) The Inventory of Depressive Symptomatology (DS): psychometric properties. Psychological Medicine, 26, 477486.
Sachs, G. S., Lafer, B., Stoll, A. L., et al (1994) A double-blind trial of bupropion versus desipramine for bipolar depression. Journal of Clinical Psychiatry, 55, 391393.
Spearing, M. K., Post, R. M., Leverich, G. S., et al (1997) Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI – BP. Psychiatry Research, 73, 159171.
Stahl, S. M., Entsuah, R. & Rudolph, R. L. (2002) Comparative efficacy between venlafaxine and SSRIs: a pooled analysis of patients with depression. Biological Psychiatry, 52, 11661174.
Suppes, T., Leverich, G. S., Keck, P. E., et al (2001) The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. Journal of Affective Disorders, 67, 4559.
Thase, M. E., Entsuah, A. R. & Rudolph, R. L. (2001) Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. British Journal of Psychiatry, 178, 234241.
Vieta, E., Martinez-Aran, A., Goikolea, J. M., et al (2002) A randomized trial comparing paroxetine and venlafaxinein the treatment of bipolar depressed patients taking mood stabilizers. Journal of Clinical Psychiatry, 63, 508512.
Young, R. C., Biggs, J. T., Ziegler, V. E., et al (1978) A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429435.
Young, L. T., Joffe, R. T., Robb, J. C., et al (2000) Double-blind comparison of addition of a second mood stabilizer versus an antidepressant to an initial mood stabilizer for treatment of patients with bipolar depression. American Journal of Psychiatry, 157, 124126.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Post et al. supplementary material
Supplementary Table S1-S2

 PDF (34 KB)
34 KB
UNKNOWN
Supplementary materials

Post et al. supplementary material
Supplementary Material

 Unknown (513 bytes)
513 bytes

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline

  • R. M. Post (a1), L. L. Altshuler (a2), G. S. Leverich (a1), M. A. Frye (a2), W A. Nolen (a3), R. W. Kupka (a4), T. Suppes (a5), S. McElroy (a6), P. E. Keck (a6), K. D. Denicoff (a7), H. Grunze (a8), J. Walden (a9), C. M. R. Kitchen (a10) and J. Mintz (a11)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *