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Metabolic Phenotypes Linked to Manic Episodes Following Antidepressant Treatment in Bipolar Disorder

A University of Gothenburg-led team has found an association between CYP2C19 metabolic phenotypes and whether someone with bipolar disorder experiences a manic episode in the months after beginning antidepressant treatment. The use of antidepressants in the treatment of bipolar disorder is controversial, the researchers note, because of that risk of mania and limited evidence of efficacy. Using data from more than 5,000 individuals from the Swedish bipolar cohort collection, the Gothenburg team examined whether being a poor or ultra-rapid metabolizer affected this emergence of mania, finding a link between CYP2C19 metabolic phenotypes and having a manic episode within three months of having started sertraline, amitriptyline, or clomipramine treatment, as they report in the Pharmacogenomics Journal. Despite this, the researchers' "results show little impact of CYP2C19 metabolic phenotypes on early treatment persistence, treatment discontinuation, or switch to another antidepressant in bipolar disorder patients taking sertraline, citalopram, escitalopram, amitriptyline, and clomipramine."