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Does the high frequency of manic symptoms in Fibromyalgia influence the choice of treatment?

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By MG Carta, et al • • January 10, 2007

Journal: Clinical Practice and Epidemiology in Mental Health. 2006 Dec 19;2(1):36 [E-publication ahead of print] Note: this is an open-access article, which means the full text will be freely available at no charge.

Authors and affiliation: Carta MG, Cardia C, Mannu F, Intilla G, Hardoy MC, Anedda C, Ruggero V, Fornasier D, Cacace E.

PMID: 17177985

Background: Mood disorders were found associated with Fibromyalgia (FM) and clinical studies have revealed the efficacy of antidepressant drugs in the treatment of FM. However, no specific instruments to identify manic symptoms were used.

Objectives: To assess the frequency of anxiety and mood disorders (particularly bipolar disorders and manic symptoms) in a consecutive sample of women affected by FM using standardized diagnostic tools and to compare the prevalence of these disorders with that observed in a sample of healthy controls from the general population.

n Cases: consecutive series of women (N=37, mean age 50,1+/- 21,0) attending a Rheumatology outpatient Unit at the University of Cagliari.

n Controls: 148 women, drawn from the data bank of an epidemiological study matched for sex and age with controls according to a randomization after blocks method.

The Italian version of the Composite International Diagnostic Interview Simplified was carried out by physicians. Psychiatric diagnosis was formulated according to DSM-IV criteria [DSM stands for the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association]. The Italian version of the Mood Disorder Questionnaire (MDQ) was administered to identify manic symptoms and bipolar disorders. Diagnosis of FM was carried out by rheumatologist according to the criteria of the American College of Rheumatology.

Results: Subjects with FM showed a higher comorbidity with Generalized Anxiety Disorder, Panic Disorder, and Major Depressive Disorder than controls. The study showed a high frequency of manic symptoms (MDQ positive) in the sample of Fibromyalgic patients (59%), approximately double that found in the control sample (P < 0.001).

Discussion: Clinical studies have shown the efficacy of antidepressants, especially tricyclic antidepressants, in the treatment of FM. The clinical difficulty in identifying hypomanic episodes is well known particularly where previous and not present episodes are concerned as in depressive patients.

These data would suggest further studies on the subject are needed and more caution also in prescribing antidepressants in a population apparently at high risk for bipolar disorders.

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