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

Background: Mood disorders were found associated with fibromyalgia and clinical studies have revealed the efficacy of antidepressant drugs in the treatment of FM. However no specific istruments to identify manic symptoms were used. Objectives: to assess the frequency of anxyety and mood disorders (particularly bipolar disorders and manic symptoms) in a consecutive sample of women affected bt FM using standardized diagnostic tools 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 randomization "after bloks" method. The Italian version of the Composite International Diagnostic Interview Simplified were carried aut by physicians. Psychiatric diagnosis was formulated according to DSM-IV criteria. The Italian version of the Mood Disorder Questionnarie (MDQ) was administered to identify manic symptoms and bipolar disorders. Diagnosis of FM were 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 Disorders than controls. The study showed a high frequency of manic symptoms (MDQ positive) in the sample of FM 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 antidepressant in a population apparentely at high risk for bipolar disorders.