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Association between antidepressant resistance in unipolar depression
and subsequent bipolar disorder: cohort study†

Cheng-Ta Li, MD Ya-Mei Bai, MD, PhD Yu-Lin Huang, MD Ying-Sheue Chen,
MD Tzeng-Ji Chen, MD, PhD Ju-Yin Cheng, MS Tung-Ping Su, MD

[http://bjp.rcpsych.org]

Cet article du British Journal of Psychiatry de janvier 2012 montre que plus de 10 % des malades chez lesquels un état dépressif majeur de type unipolaire avait été diagnostiqué et qui ne répondait pas à un traitement antidépresseur bien mené, avaient en réalité un trouble bipolaire sous-jacent qui n'a été reconnu qu'au bout de 2 à 3 ans.
Les ATCD personnels, familiaux, l'absence éventuelle d'évènement déclanchant, etc... doivent être analysés et une modification de traitement en fonction de cette possiblité doit être envisagée.

Revoir :
---- Troubles bipolaires [Lire]
---- Prodromes et premiers symptômes des troubles bipolaires [Lire]


Background
People with major depressive disorder who fail to respond to adequate trials of antidepressant treatment may harbour hidden bipolar disorder.

Aims
We aimed to compare the rates of a change in diagnosis to bipolar disorder among people with major depressive disorder with stratified responses to antidepressants during an 8-year follow-up period.

Method
Information on individuals with major depressive disorder identified during 2000 (cohort 2000, n = 1485) and 2003 (cohort 2003, n = 2459) were collected from a nationally representative cohort of 1 000 000 health service users in Taiwan. Participants responding well to antidepressants were compared with those showing poor responses to adequate trials of antidepressants.

Results
In 7.6-12.1% of those with a diagnosis of unipolar major depressive disorder this diagnosis was subsequently changed to bipolar disorder, with a mean time to change of 1.89-2.98 years. Difficult-to-treat participants presented higher rates of change to a bipolar diagnosis (25.6% in cohort 2000; 26.6% in cohort 2003) than easy-to-treat participants (8.8-8.9% in cohort 2000; 6.8-8.6% in cohort 2003; P<0.0001). Regression analysis showed that the variable most strongly associated with the change in diagnosis was antidepressant use history. The difficult-to-treat participants were associated most with diagnostic changing (cohort 2000: odds ratio (OR) = 1.88 (95% CI 1.12-3.16); cohort 2003: OR = 4.94 (95% CI 2.81-8.68)).

Conclusions
This is the first large-scale study to report an association between antidepressant response history and subsequent change in diagnosis from major depressive disorder to bipolar disorder. Our findings support the view that a history of poor response to antidepressants in unipolar depression could be a useful predictor for bipolar diathesis.

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