Conference paper
ARE SSRIs RESPONSIBLE FOR PRECIPITATING SUICIDAL IDEATION IN TEENAGERS WITH ‘SUBSYNDROMAL’ BIPOLAR AFFECTIVE DISORDER WHO HAVE BEEN MISDIAGNOSED WITH UNIPOLAR DEPRESSION?
Stephen Hogg
; Clinical School, University of Cambridge, Cambridge, UK
Sereena Ansari
; Clinical School, University of Cambridge, Cambridge, UK
Qasim Masood
; Clinical School, University of Cambridge, Cambridge, UK
Mark Agius
; Clare College, Cambridge, UK
Zoltan Rihmer
; Semmelweis University, Budapest, Hungary
Abstract
Concerns have recently been raised about a possible link between suicidal ideation and the use of SSRIs in teenagers diagnosed
with unipolar depression, such that the USA FDA and UK CSM have issued warnings regarding the use of SSRIs in adolescents with
depression. We investigated this phenomenon first by recognizing that the initial presentation of unipolar and bipolar depression
may only differ in subtle ways and with the result being that a significant number of patients are misdiagnosed at the expense of
patient outcomes. This is especially pertinent as patients with bipolar disorder have increased lifetime rates of suicide as compared
with those patients with unipolar depression. The normal developmental trajectory of bipolar disorder often involves recurrent
depressive episodes in early adolescence before the development of hypomanic/manic episodes. Therefore, a misdiagnosis of bipolar
disorder as unipolar depression in teenagers could explain the failure of SSRIs to adequately treat depressive episodes. A suboptimal
response to SSRIs and so a lack of control of the depression is a risk factor for suicide. One reason for this suboptimal response is
the markedly different neurotransmission involved in bipolar depression as compared to the neurotransmitter systems operated on by
SSRIs. In bipolar disorder, dopamine is the principal neurotransmitter disrupted and we marshal structural, pharmacological and
biochemical evidence to support this claim. One important strand of evidence involves polymorphisms in D1 and D2 dopamine
receptors being implicated in the pathogenesis of bipolar affective disorder. Serotonin neurotransmission is affected by SSRIs,
however the role of serotonin in bipolar disorder is much more ambiguous. The conclusion we arrive at is that the link between
suicidality and SSRI use in adolescents diagnosed with unipolar depression may in fact be due to inappropriate treatment of
misdiagnosed bipolar disorder that has yet to manifest with hypomanic/manic symptoms.
Keywords
bipolar affective disorder; serotonin selective reuptake inhibitors (SSRIs); unipolar depression; subsyndromal bipolar disorder; suicide
Hrčak ID:
264904
URI
Publication date:
30.8.2016.
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