BACKGROUND: It has been proposed that antidepressants can induce a chronic, dysphoric, irritable state in bipolar patients (called ACID for antidepressant-associated chronic irritable dysphoria). This phenomenon has only been described in case series format, and has not been prospectively validated. METHODS: Prospective data from the first 1500 patients (62.7% with bipolar I, 30.1% with bipolar II, and 7.2% with NOS) treated in the STEP-BD database were examined and those who were euthymic for at least one month at study entry, subsequently developed a depressive episode, and were then followed for one year were identified. Outcome of those who received an antidepressant for this depressive episode (n=27) was compared to those who did not (n=56), with particular attention given to the presence of the proposed symptom triad of ACID, namely dysphoria, irritability, and middle insomnia. RESULTS: Patients treated with antidepressants were ten times more likely to develop ACID than those who were not (Hazard ratio=9.95, CI=1.103-89.717, P=0.04). However, the hazard ratio dropped to 1.05 (P=0.99) when corrected for significant covariates, notably past antidepressant-related manic switch and sex. DISCUSSION: This study does not support the existence of ACID as an independent phenomenon. Rather, ACID appears to be part of a broader spectrum of antidepressant treatment-emergent affective switches.
BACKGROUND: It has been proposed that antidepressants can induce a chronic, dysphoric, irritable state in bipolarpatients (called ACID for antidepressant-associated chronic irritable dysphoria). This phenomenon has only been described in case series format, and has not been prospectively validated. METHODS: Prospective data from the first 1500 patients (62.7% with bipolar I, 30.1% with bipolar II, and 7.2% with NOS) treated in the STEP-BD database were examined and those who were euthymic for at least one month at study entry, subsequently developed a depressive episode, and were then followed for one year were identified. Outcome of those who received an antidepressant for this depressive episode (n=27) was compared to those who did not (n=56), with particular attention given to the presence of the proposed symptom triad of ACID, namely dysphoria, irritability, and middle insomnia. RESULTS:Patients treated with antidepressants were ten times more likely to develop ACID than those who were not (Hazard ratio=9.95, CI=1.103-89.717, P=0.04). However, the hazard ratio dropped to 1.05 (P=0.99) when corrected for significant covariates, notably past antidepressant-related manic switch and sex. DISCUSSION: This study does not support the existence of ACID as an independent phenomenon. Rather, ACID appears to be part of a broader spectrum of antidepressant treatment-emergent affective switches.
Authors: Konstantinos N Fountoulakis; Lakshmi Yatham; Heinz Grunze; Eduard Vieta; Allan Young; Pierre Blier; Siegfried Kasper; Hans Jurgen Moeller Journal: Int J Neuropsychopharmacol Date: 2017-02-01 Impact factor: 5.176
Authors: Isabella Pacchiarotti; David J Bond; Ross J Baldessarini; Willem A Nolen; Heinz Grunze; Rasmus W Licht; Robert M Post; Michael Berk; Guy M Goodwin; Gary S Sachs; Leonardo Tondo; Robert L Findling; Eric A Youngstrom; Mauricio Tohen; Juan Undurraga; Ana González-Pinto; Joseph F Goldberg; Ayşegül Yildiz; Lori L Altshuler; Joseph R Calabrese; Philip B Mitchell; Michael E Thase; Athanasios Koukopoulos; Francesc Colom; Mark A Frye; Gin S Malhi; Konstantinos N Fountoulakis; Gustavo Vázquez; Roy H Perlis; Terence A Ketter; Frederick Cassidy; Hagop Akiskal; Jean-Michel Azorin; Marc Valentí; Diego Hidalgo Mazzei; Beny Lafer; Tadafumi Kato; Lorenzo Mazzarini; Anabel Martínez-Aran; Gordon Parker; Daniel Souery; Ayşegül Ozerdem; Susan L McElroy; Paolo Girardi; Michael Bauer; Lakshmi N Yatham; Carlos A Zarate; Andrew A Nierenberg; Boris Birmaher; Shigenobu Kanba; Rif S El-Mallakh; Alessandro Serretti; Zoltan Rihmer; Allan H Young; Georgios D Kotzalidis; Glenda M MacQueen; Charles L Bowden; S Nassir Ghaemi; Carlos Lopez-Jaramillo; Janusz Rybakowski; Kyooseob Ha; Giulio Perugi; Siegfried Kasper; Jay D Amsterdam; Robert M Hirschfeld; Flávio Kapczinski; Eduard Vieta Journal: Am J Psychiatry Date: 2013-11 Impact factor: 18.112