Neglected but not negligible aspects of antidepressants and their availability in bipolar depression
Abstract Objectives Although many antidepressants are available, they are not always used appropriately. For appropriate use of antidepressants, the old concept of a linear dose–response relationship, in which the dose is linearly increased to achieve a sufficient antidepressant effect, should be re...
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| Format: | Article |
| Language: | English |
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Wiley
2021-08-01
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| Series: | Brain and Behavior |
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| Online Access: | https://doi.org/10.1002/brb3.2308 |
| _version_ | 1797754641666015232 |
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| author | Takeshi Terao |
| author_facet | Takeshi Terao |
| author_sort | Takeshi Terao |
| collection | DOAJ |
| description | Abstract Objectives Although many antidepressants are available, they are not always used appropriately. For appropriate use of antidepressants, the old concept of a linear dose–response relationship, in which the dose is linearly increased to achieve a sufficient antidepressant effect, should be reconsidered. Furthermore, there is ongoing debate on the safe and appropriate use of antidepressants in patients with bipolar depression. Antidepressants may be used under certain conditions in patients with bipolar depression. These neglected—but not negligible—aspects of antidepressants have been discussed herein. Methods A narrative qualitative review Results Dose–response relationships of antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are not linear. They may be bell‐shaped, with efficacy initially increasing with an increase in dose but decreasing when the dose is increased beyond a certain point. Despite using international diagnostic criteria, uncertainty remains on whether operationally diagnosed depression is latent bipolar I depression, latent bipolar II depression, or true depression. Furthermore, operationally diagnosed bipolar II depression may be latent bipolar I depression, true bipolar II depression, or depression with false hypomanic episodes. Manic/hypomanic switches are most likely to occur in patients receiving tricyclic antidepressants, followed by those receiving serotonin and noradrenaline reuptake inhibitors and SSRIs, in that order. Also, these switches are most likely to occur in patients with bipolar I depression, followed by those with bipolar II depression and true depression, in that order. Conclusions Considering the diagnostic subtype of bipolar depression and antidepressant properties may help to determine the optimal treatment strategy. |
| first_indexed | 2024-03-12T17:36:27Z |
| format | Article |
| id | doaj.art-359cede1196b44b7ad8d5ff84889b246 |
| institution | Directory Open Access Journal |
| issn | 2162-3279 |
| language | English |
| last_indexed | 2024-03-12T17:36:27Z |
| publishDate | 2021-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Brain and Behavior |
| spelling | doaj.art-359cede1196b44b7ad8d5ff84889b2462023-08-04T10:56:25ZengWileyBrain and Behavior2162-32792021-08-01118n/an/a10.1002/brb3.2308Neglected but not negligible aspects of antidepressants and their availability in bipolar depressionTakeshi Terao0Department of Neuropsychiatry Oita University Faculty of Medicine Yufu Oita JapanAbstract Objectives Although many antidepressants are available, they are not always used appropriately. For appropriate use of antidepressants, the old concept of a linear dose–response relationship, in which the dose is linearly increased to achieve a sufficient antidepressant effect, should be reconsidered. Furthermore, there is ongoing debate on the safe and appropriate use of antidepressants in patients with bipolar depression. Antidepressants may be used under certain conditions in patients with bipolar depression. These neglected—but not negligible—aspects of antidepressants have been discussed herein. Methods A narrative qualitative review Results Dose–response relationships of antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are not linear. They may be bell‐shaped, with efficacy initially increasing with an increase in dose but decreasing when the dose is increased beyond a certain point. Despite using international diagnostic criteria, uncertainty remains on whether operationally diagnosed depression is latent bipolar I depression, latent bipolar II depression, or true depression. Furthermore, operationally diagnosed bipolar II depression may be latent bipolar I depression, true bipolar II depression, or depression with false hypomanic episodes. Manic/hypomanic switches are most likely to occur in patients receiving tricyclic antidepressants, followed by those receiving serotonin and noradrenaline reuptake inhibitors and SSRIs, in that order. Also, these switches are most likely to occur in patients with bipolar I depression, followed by those with bipolar II depression and true depression, in that order. Conclusions Considering the diagnostic subtype of bipolar depression and antidepressant properties may help to determine the optimal treatment strategy.https://doi.org/10.1002/brb3.23085‐HT1A autoreceptorantidepressantsbipolar depressiondose–response relationshipselective serotonin reuptake inhibitors |
| spellingShingle | Takeshi Terao Neglected but not negligible aspects of antidepressants and their availability in bipolar depression Brain and Behavior 5‐HT1A autoreceptor antidepressants bipolar depression dose–response relationship selective serotonin reuptake inhibitors |
| title | Neglected but not negligible aspects of antidepressants and their availability in bipolar depression |
| title_full | Neglected but not negligible aspects of antidepressants and their availability in bipolar depression |
| title_fullStr | Neglected but not negligible aspects of antidepressants and their availability in bipolar depression |
| title_full_unstemmed | Neglected but not negligible aspects of antidepressants and their availability in bipolar depression |
| title_short | Neglected but not negligible aspects of antidepressants and their availability in bipolar depression |
| title_sort | neglected but not negligible aspects of antidepressants and their availability in bipolar depression |
| topic | 5‐HT1A autoreceptor antidepressants bipolar depression dose–response relationship selective serotonin reuptake inhibitors |
| url | https://doi.org/10.1002/brb3.2308 |
| work_keys_str_mv | AT takeshiterao neglectedbutnotnegligibleaspectsofantidepressantsandtheiravailabilityinbipolardepression |