Antidepressant-induced mood conversions in bipolar disorder: a retrospective study of tricyclic versus non-tricyclic antidepressant drugs.

OBJECTIVES: The aim of this retrospective study was an analysis of antidepressant-induced mood conversions to mania/hypomania occurring in bipolar inpatients treated with antidepressants in the Affective Disorder Unit of the Institute of Psychiatry and Neurology, Warsaw, in the years 1972-1996. METHODS: The data for analysis were obtained retrospectively from clinical records. In a subgroup of patients prone to mood conversions, a comparison was done of depressive episodes treated with antidepressants with and without a switch to mania/hypomania as well as the frequency of mood conversions induced by particular antidepressant drugs, especially tricyclic (TCA) versus non-TCA drugs. RESULTS: Among 333 bipolar patients hospitalized in this period, mood conversions were observed in 118 subjects, significantly more frequently in female (44%) than in male patients (25%), and in patients with depressive episode at the onset of illness (80 vs. 40%). Among mood converters, it was found that the depressive episodes with a switch to mania were less severe, shorter, and with shorter duration of antidepressant treatment. The risk of switching was higher during treatment with TCA than with non-TCA drugs (36 vs. 17%), the highest with amitriptyline (42% of treated episodes), imipramine (40%) and clomipramine (35%). CONCLUSIONS: Our results suggest that bipolar patients prone to mood conversion constitute one third of the inpatient population with this illness. The switch from depression to mania occurred significantly more frequently during treatment with TCA than with non-TCA drugs. It is hypothesized that anticholinergic activity may contribute to the higher frequency of TCA-induced mood conversions.

[CYP 2D6 activity profile among patients with depression]. / Profil aktywnosci cytochromu CYP 2D6 w grupie chorych na depresje.

AIM: The aim of this work was to establish the profile of CYP 2D6 activity among patients with depressive disorders, and compare it with the literature data on this activity among healthy volunteers, recruited from the Polish population. METHOD: The debrisoquine test was used to determine CYP 2D6 activity. Debrisoquine metabolic ratio (MR) was determined with the use of high performance liquid chromatography with spectrophotometric detection. Our results were compared with the results obtained with the use of an analogous method in the study performed at the Institute of Cardiology in Warsaw on 154 healthy controls. RESULTS: The percentage of "ultra-fast metabolizers" was 1.03% in the group of patients with depression, and 1.3% in the group of healthy volunteers. The percentages of the "slow metabolizers" in both groups were 5.1% and 5.6% respectively. Also, the percentages of persons considered to be at an increased risk of undesirable side effects from drugs metabolized by CYP 2D6, i.e. persons with debrisoquine metabolic ratio values above 4 were nearly identical in both groups (11.3 and 11.6%). CONCLUSION: The results showed that CYP 2D6 activity profiles were practically identical in both groups. This indicates that there is no relationship between CYP 2D6 gene expression, as measured by the debrisoquine test, and affective disorders morbidity.

[Evaluation of clinical and psychological methods in estimating antidepressants efficacy in treatment of depression (preliminary report)]. / Ocena przydatnosci wybranych metod klinicznych i baterii testów do pomiaru procesów poznawczych jako wskazników skutecznosci dzialania leków przeciwdepresyjnych (doniesienie wstepne).

The aim of the study was to evaluate the onset of action of antidepressants using CGI i CGI Improvement, MADRS, Self Analogue Scale and Wiener Battery Test System. Onset of action of antidepressants was evaluated in a group of 18 patients with major depression. Evaluation was assessed at 4, 8, 10, 14, 28 days of treatment. Significant reduction of symptoms in MADRS at day 8 was the predictor of effect at day 28. Reduction of symptoms in MADRS was not correlated with improvement in cognitive functions. Most of the psychological tests showed to be not sensitive enough to estimate a change in cognitive processes under pharmacotherapy.