Cited by 93Bipolar Disorder and TreatmentTreatment of Major DepressionSchizophrenia research and treatment

Incidence, prevalence and clinical correlates of antidepressant-emergent mania in bipolar depression: a systematic review and meta-analysis

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Fornaro, Michele, Anastasia, Annalisa, Novello, Stefano, Fusco, Andrea, Solmi, Marco, Monaco, Francesco, Veronese, Nicola, De Berardis, Domenico +1 more·2018·Bipolar Disorders

Abstract

Background: Treatment‐emergent mania (TEM) represents a common phenomenon inconsistently reported across primary studies, warranting further assessment. Methods: A systematic review and meta‐analysis following the Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) and Meta‐Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were conducted. Major electronic databases were searched from inception to May 2017 to assess the incidence and prevalence rates and clinical features associated with manic switch among bipolar depressed patients receiving antidepressants, using meta‐regression and subgroup analysis. Results: Overall, 10 098 depressed patients with bipolar disorder (BD) across 51 studies/arms were included in the quantitative analysis. The cumulative incidence of cases (TEM+) among 4767 patients with BD over 15 retrospective studies was 30.9% (95% confidence interval [CI] 19.6‐45.0%, I2 = 97.9%). The cumulative incidence of TEM+ among 1929 patients with BD over 12 prospective open studies was 14.4% (95% CI 7.4‐26.1%, I2 = 93.7%). The cumulative incidence of TEM+ among 1316 patients with BD over 20 randomized controlled trials (RCT s) was 11.8% (95% CI 8.4‐16.34%, I2 = 73.46%). The pooled prevalence of TEM+ among 2086 patients with BD over four cross‐sectional studies was 30.9% (95% CI 18.1‐47.4%, I2 = 95.6%). Overall, concurrent lithium therapy predicted the lowest TEM rates. Inconsistent operational definitions of TEM were recorded, and the lack of information about age, sex, co‐occurring anxiety, and other clinically relevant moderators precluded further stratification of the results. Conclusions: Rates of TEM vary primarily depending on study setting, which is concordant with the high degree of heterogeneity of the included records. Forthcoming RCT studies should adopt consistent operational definitions of TEM and broaden the number of moderators, in order to contribute most effectively to the identification of clear‐cut sub‐phenotypes of BD and patient‐tailored pharmacotherapy.

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Authors
Fornaro, M., Anastasia, A., Novello, S., Fusco, A., Solmi, M., Monaco, F., Veronese, N., De Berardis, D., & de Bartolomeis, A.
Affiliations
  • Federico II University Hospital (IT)
  • University of Padua (IT)
  • University of Salerno (IT)
  • Azienda Ospedale - Università Padova (IT)
  • National Health Service Department of Mental Health Psychiatric Service of Diagnosis and Treatment Teramo Italy
  • Section of Psychiatry Department of Neuroscience, Reproductive Sciences and Odontostomatology Federico II University Naples Italy
Corresponding author
Fornaro, Michele
Venue
Bipolar Disorders
Publisher
Wiley
Published
2018-02-14
Volume
20
Issue
3
Pages
195-227
ISSN
  • 1398-5647 (ISSN-L)
  • 1399-5618
OpenAlex
W2790303747
Cited by
93
References
86
Citations by year
2026: 15 · 2025: 9 · 2024: 8 · 2023: 12 · 2022: 8 · 2021: 11 · 2020: 16 · 2019: 7 · 2018: 7
FWCI
1.56
Type
journal article
Language
en
Open access
Locations
  • Bipolar Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Funders
International Society for Bipolar Disorders
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
treatment-emergent mania, antidepressant-induced mania, bipolar depression, bipolar disorder, antidepressants, incidence, prevalence, manic switch, operational definitions
MeSH terms
Antidepressive Agents, Bipolar Disorder, Depression, Humans, Incidence, Prevalence

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