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P0157 - Why clinicians maintain antidepressants in some patients with acute mania? Hints from a large, observational study (EMBLEM)

Published online by Cambridge University Press:  16 April 2020

A.R. Rosa ,
N. Cruz ,
C. Franco ,
J.M. Haro ,
J. Bertsch ,
C. Reed ,
T. Aarre ,
J. Sanchez-Moreno  and
E. Vieta
A.R. Rosa
Affiliation:
Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Spain Bipolar Disorder Program, Centro de Pesquisas, Clinic Hospital, Porto Alegre, Brazil
N. Cruz
Affiliation:
Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Spain
C. Franco
Affiliation:
Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Spain Hospital General Universitario Gregorio Maranon, Madrid, Spain
J.M. Haro
Affiliation:
Sant Joan de Deu-SSM, Fundacio Sant Joan de Deu, Barcelona, Spain
J. Bertsch
Affiliation:
Sant Joan de Deu-SSM, Fundacio Sant Joan de Deu, Barcelona, Spain
C. Reed
Affiliation:
Lilly Research Centre, Windlesham, UK
T. Aarre
Affiliation:
Nordfjord Psychiatric Clinic, Nordfjordeid, Norway
J. Sanchez-Moreno
Affiliation:
Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Spain
E. Vieta
Affiliation:
Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Spain McLean Hospital, Harvard Medical School, Boston, MA, USA

Abstract

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Aim:

Antidepressants are recommended to be withdrawn during a manic episode. This analysis explored the characteristics of patients receiving antidepressants during an acute manic episode in the context of a large, observational study.

Method:

EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) is a 2-year prospective observational study of acute mania/mixed mania. Of 2416 patients, 345 (14%) were taking an antidepressant (AD) and 2071 (86%) were not (NAD) during acute mania. Demographic and clinical variables were collected at baseline and at outpatient visits up to 2 years. Illness severity was measured using Clinical Global Impressions–Bipolar Disorder (CGI-BP), 5-item Hamilton Depression Rating Scale (HAM-D-5), and Young Mania Rating Scale (YMRS). Logistic regression analysis was used to identify variables associated with AD use.

Results:

AD use varied across countries (p<0.05), more use with mixed episodes (p<0.001), rapid cyclers (p=0.02), more previous depressive episodes (p<0.001) and higher HAM-D-5 severity at baseline (p<0.001) but less use with higher education (p=0.029), YMRS (p=0.022), CGI-BP overall (p=0.006) severity and inpatients at baseline (p<0.001). There were no differences in alcohol abuse or suicide attempts. Depression recurrence rates were significantly higher with AD (p<0.001).

Conclusions:

The EMBLEM study suggests that patients with mania receiving antidepressants are more likely to be outpatients with mixed mania or rapid cycling, and have a higher risk of depressive recurrence during follow-up. Clinicians seem to maintain antidepressants in manic patients to address depressive features during mania and prevent further depressive episodes.

EMBLEM was supported by Eli Lilly and Company.

Type
Poster Session II: Bipolar Disorders
Information
European Psychiatry , Volume 23 , Issue S2: 16th AEP Congress - Abstract book - 16th AEP Congress , April 2008 , pp. S238
Copyright
Copyright © European Psychiatric Association 2008
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