Treatment and outcome of antidepressant treatment-associated hypomania in unipolar major depression: A 3-year follow-up study

Background: The main aim of this study was to propose a standardized acute and maintenance/continuation treatment protocol for acute antidepressant treatment-associated hypomania (AAH) in major unipolar depression. The second objective was to describe outcomes at three-year follow-up in a cohort of patients with AAH who had been included in this standardized therapeutic protocol. Methods: The study consisted of two distinct prospective phases: a 1-year follow-up first phase in which all consecutive patients with a diagnosis of moderate/severe unipolar depressive disorder received acute and continuation/maintenance antidepressant treatment; and a second phase, in which patients who had suffered AAH during the first phase were admitted to a 3-year follow-up with the authors-designed standardized acute and continuation/maintenance treatment protocol. Results: In our patient sample, the reintroduction of antidepressant treatment according to the proposed protocol was not accompanied by new AAH episodes following 11-36 months of pharmacological antidepressant treatment The second notable result was that no subject presented manic episodes or spontaneous hypomania (once antidepressant maintenance treatment had finished) during three years of follow-up. Limitations: We should be cautious when generalizing these results to patients with mild major depressive episode or other type of unipolar affective disorder. Conclusions: Based on these results, we should not refuse the prescription of antidepressant drugs to patients with unipolar depression and subsequent AAH. The treatment protocol which we describe in this study can serve as a basis for future studies and, in anticipation of future consensus, as a practical proposal for clinical psychiatrists. (C) 2013 Elsevier B.V. All rights reserved