Antidepressant-associated chronic irritable dysphoria (ACID) in STEP-BD patients

Background been proposed that antidepressants can induce a chronic, dysphoric, irritable state in bipolar patients (called ACID for antidepressant-associated chronic irritable dysphoria). This phenomenon has only been described in case series format, and has not been prospectively validated. s ctive data from the first 1500 patients (62.7% with bipolar I, 30.1% with bipolar II, and 7.2% with NOS) treated in the STEP-BD database were examined and those who were euthymic for at least one month at study entry, subsequently developed a depressive episode, and were then followed for one year were identified. Outcome of those who received an antidepressant for this depressive episode (n = 27) was compared to those who did not (n = 56), with particular attention given to the presence of the proposed symptom triad of ACID, namely dysphoria, irritability, and middle insomnia. s ts treated with antidepressants were ten times more likely to develop ACID than those who were not (Hazard ratio = 9.95, CI = 1.103–89.717, P = 0.04). However, the hazard ratio dropped to 1.05 (P = 0.99) when corrected for significant covariates, notably past antidepressant-related manic switch and sex. sion tudy does not support the existence of ACID as an independent phenomenon. Rather, ACID appears to be part of a broader spectrum of antidepressant treatment-emergent affective switches.