@article{ref1,
title="Antidepressant monotherapy in pre-bipolar depression; predictive value and inherent risk",
journal="Journal of affective disorders",
year="2008",
author="O'Donovan, Claire and Garnham, Julie S. and Hajek, Tomas and Alda, Martin",
volume="107",
number="1-3",
pages="293-298",
abstract="OBJECTIVE: To identify specific treatment-emergent symptoms in response to antidepressant therapy in depression preceding bipolar disorder. METHODS: Retrospective chart review of response to antidepressants in &quot;pre-bipolar&quot; depression, compared to a matched unipolar sample. RESULTS: Family history of completed suicide (p=0.0003) and bipolar disorder (p=0.004) were more common in the pre-bipolar subgroup. Earlier age of onset of diagnosed depression (p=0.005) as well as even earlier episodes of untreated retrospectively diagnosed major depression (p<0.0001) were associated with a future bipolar course. The pre-bipolar group was less likely to respond to antidepressant treatment (p=0.009). Treatment-emergent &quot;mixed&quot; symptoms (two or more symptoms of DSM IV mania, mood lability, irritability/rage with co-existing depression) and in particular, &quot;serious symptoms&quot; (treatment emergent or increased agitation, rage or suicidality) occurred more commonly in the bipolar group. The two variables that best accounted for the between-group differences in logistic regression, were early age at first symptoms of depression and treatment-emergent agitation. CONCLUSIONS: Family history of completed suicide and/or bipolar disorder, early onset of depressive symptoms as well as treatment-emergent &quot;mixed&quot; symptoms are common in depression preceding the diagnosis of bipolar disorder.<p /> <p>Language: en</p>",
language="en",
issn="0165-0327",
doi="10.1016/j.jad.2007.08.003",
url="http://dx.doi.org/10.1016/j.jad.2007.08.003"
}