Nesrin TOMRUK, Ömer SAATÇİOĞLU, BURCU RAHŞAN ERİM, Nihat ALPAY

Bipolar I bozukluk ve antidepresana bağlı mani/hipomani klinik özelliklerinin karşılaştırılması

Amaç: Antidepresan tedavisi sırasında gelişen hipomani/mani klinisyenler tarafından sıklıkla gözden kaçırılmaktadır. Son gelişmelere göre, bipolarite, günümüzde geniş bir spektrum olarak kabul edilmektedir. Bipolar bozukluğu olan hastaların yaklaşık %40’ı yanlış tanı almakta ya da doğru tanı hastalığın daha ileri evrelerinde konulmaktadır. Antidepresan kullanımı ile ilişkili hipomani/mani için özgün tanı ölçütleri bulunmamaktadır. Bu hastalar bipolar spektruma dahil edilmemiştir. Bu çalışmada, bipolar I bozukluğun ve antidepresan kullanımına bağlı olarak ortaya çıkan mani/hipomaninin klinik özellikleri karşılaştırılarak farklı yönlerinin ortaya konması ve bipolar bozukluk içerisindeki yeri tartışılmıştır. Yöntem: Bu çalışmaya, polikliniğe başvuran 84 ardışık hasta alınmıştır. Bu hastaların 40’ına antidepresan kullanımına bağlı hipomani/mani, 44’üne ise DSM-IV kriterlerine göre bipolar I tanısı konulmuştur. Tüm hastalara SCID-I ile sosyodemografik ve klinik özellikleri sorgulayan bir form uygulanmıştır. Bulgular: Her iki gruptaki hastaların çoğu kadındı. Bipolar I grubunun akrabalarında majör depresyon oranı, antidepresan ile indüklenen mani/hipomani grubundakinden daha düşüktü. Antidepresanla ilişkili mani/hipomani, bipolar I grubu hastalarına göre, daha hafif şiddette bir bozukluk olarak saptandı. Sonuç: Bulgularımız, antidepresan kullanımına bağlı gelişen mani/hipomaninin bipolar bozukluklar içinde ayrı bir alt grupta sınıflandırılması gerektiğini düşündürmektedir.

A comparison of clinical characteristics in bipolar I disorder and antidepressant-associated mania/hypomania

Objective: Although hypomania/mania during antidepressant treatment is not rare, it is often neglected by clinicians. As a result of the recent developments in this topic, bipolarity is now accepted as a wide spectrum. Forty percent of the patients with bipolar disorder have been misdiagnosed or diagnosed in later stages of illness. There are no specific diagnostic criteria for antidepressant-induced hypomania/mania. These patients have not been included in bipolar spectrum. In this study, we aimed to compare clinical features of BP I and antidepressant-induced hypomania/mania, and discussed bipolar spectrum disorders. Method: In this study, 84 consecutive patients who referred to outpatient unit were selected. Forty of the patients were diagnosed as antidepressant-induced mania or hypomania, and 44 of them as BP I disorder according to DSM-IV criteria. All patients were given SCID-I and a data form which included sociodemographic characteristics and clinical features. Results: The majority of the patients in both groups were female. The rate of major depression among the relatives of BP I group was significantly lower than antidepressant induced manic or hypomanic group. Antidepressant-associated mania or hypomania has been observed as a milder disorder compared to BP I. Conclusions: Our results suggest that antidepressant-associated mania or hypomania should be categorized as a different subgroup in bipolar disorders.

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