Cited by 177Bipolar Disorder and TreatmentTreatment of Major DepressionPersonality Disorders and Psychopathology

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

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Li, Cheng-Ta, Bai, Ya-Mei, Huang, Yu-Lin, Chen, Ying-Sheue, Chen, Tzeng-Ji, Cheng, Ju-Yin, Su, Tung-Ping·2012·British Journal of Psychiatry

DOI 10.1192/bjp.bp.110.086983

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Abstract

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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Authors: Li, C.-T., Bai, Y.-M., Huang, Y.-L., Chen, Y.-S., Chen, T.-J., Cheng, J.-Y., & Su, T.-P.
Affiliations: Taipei Veterans General Hospital (TW)
National Yang Ming University (TW)
Corresponding author: Su, Tung-Ping
ORCID: Li, Cheng-Ta
Bai, Ya-Mei
Chen, Tzeng-Ji
Su, Tung-Ping
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 2012-01
Volume: 200
Issue: 1
Pages: 45-51
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/bjp.bp.110.086983
OpenAlex: W2164793282
Cited by: 177
References: 24
Citations by year: 2026: 10 · 2025: 11 · 2024: 10 · 2023: 10 · 2022: 10 · 2021: 9 · 2020: 9 · 2019: 9 · 2018: 12 · 2017: 13 · 2016: 13 · 2015: 12 · 2014: 17 · 2013: 17 · 2012: 14
FWCI: 10.50
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified, 2193 d)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Health Research Institutes
Taipei Veterans General Hospital
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords: antidepressant resistance, unipolar major depression, bipolar disorder, antidepressant response, diagnostic change, treatment-resistant depression
MeSH terms: Adult, Antidepressive Agents, Anxiety Disorders, Bipolar Disorder, Major Depressive Disorder, Diagnosis, Differential, Disease Susceptibility, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Taiwan, Outcome Assessment, Health Care, Substance-Related Disorders, International Classification of Diseases, Depressive Disorder, Treatment-Resistant

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

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