Mania MCQ

[sujalneuro]

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Which of the following statements about manic switch following treatment with antidepressants is true?. Answer is "D" but why ??....Please explain the answer

A. Paroxetine has shown a higher switch rate than venlafaxine
B. The rate of switching to mania or hypomania is greater with
bupropion than with desipramine
C. Switch rates are higher with the newer antidepressants than
with tricyclic antidepressants
D. There is an association between noradrenergic affinity and switch to manic or hypomanic episodes
E. There is no significant difference between sertraline, venlafaxine and bupropion in causing manic switch

 

[Merovinge]

Rates of switch to Mania tend to be grouped roughly as follows among the medications included in that stem although this is far from a settled area of research.

Least

SSRI
Bupropion

SNRI

TCAs

Most

Notably the dual effect of noradrenergic plus 5ht is generally thought to be more likely to cause a manic switch. Also, the other 4 answers are clearly wrong!

 

[shan564]

Agree with the above. TCAs and SNRIs are both noradrenergic, and both are much more likely to cause flip to mania than SSRIs. Based on that, it's natural to deduce that noradrenergic activity increases the risk of the switch.

 

[splik]

this is a terrible question because the stem is unfocussed, and while the distractors are all wrong, the key is also wrong! There isn't an association between noradrenergic affinity and switch to mania that has been demonstrate and it is wrong to suggest it is "natural to deduce that noradrenergic activity increases the switch" (and even if that were deduced the question would still be terrible because you shouldn't be testing guesses). The data suggest dual-acting actions are more likely to cause switching which is not surprising. This is an entirely different conclusion. reboxetine which is a selective NARI does not appear to have a significant switch rate based on the limited data. also bupropion was believed to have a lower switch rate and it is also inhibits the NET.

 

[Merovinge]

It's definitely a bad question, I think the person writing it essentially looked at several articles available on an area with scant high quality evidence and piecemealed responses. They basically created 4 wrong answers based on some available literature and then crafted the "right" answer as something vague that couldn't necessarily be shown wrong with the papers in front of them.

As an aside, a key to excelling on multiple-choice questions, (a largely useless skill by this time in life), is understanding what point the author of the question is trying to make. I can often sniff out the "agenda" of PRITE questions and use that to guide me if it isn't a particularly concrete question with obvious answer.

For example,
http://www.ncbi.nlm.nih.gov/pubmed/12088162 - May have been the inspiration for option A
http://bjp.rcpsych.org/content/189/2/124.full.pdf - May have been the inspiration for option E
http://bjp.rcpsych.org/content/164/4/549.short - May have been the inspiration for option C (although I'm sure there are several articles making this point)