The high frequency of manic symptoms in fibromyalgia does influence the choice of treatment?

Mauro Giovanni Carta¹ , Claudia Cardia¹ , Francesca Mannu¹ , Gesuina Intilla¹ , Maria Carolina Hardoy¹ , C Anedda² , V Ruggero² , D Fornasier² and Enrico Cacace²

¹Psychiatry, Department of Public Health, University of Cagliari, Italy

²Rheumatology, Department of Internal Medicine, University of Cagliari, Italy

author email corresponding author email

Clinical Practice and Epidemiology in Mental Health 2006, 2:36doi:10.1186/1745-0179-2-36


Published:	19 December 2006

Abstract

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.

Methods

Cases: consecutive series of women (N = 37, mean age 50.1 ± 21.0) attending a Rheumatology outpatient Unit at the University of Cagliari. Controls: 148 women, drawn from the data bank of an epidemiological study matched for sex and age with controls according to a randomisation "after blocks" method. The Italian version of the Composite International Diagnostic Interview Simplified were carried out by physicians. Psychiatric diagnosis was formulated according to DSM-IV criteria. The Italian version of the Mood Disorder Questionnaire (MDQ) was administered to identify manic symptoms and bipolar disorders. Diagnosis of FM were carried out by rheumatologist according to the criteria of American College of Rheumatology.

Results

Subjects with FM showed a higher comorbidity with Generalised 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.