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Drug Safety

, Volume 26, Issue 5, pp 337–351 | Cite as

Avoiding Drug-Induced Switching in Patients with Bipolar Depression

  • Chantal Henry
  • Jacques Demotes-Mainard
Review Article

Abstract

Antidepressant-induced switching is a major risk during the treatment of bipolar depression. Despite several clinical studies, questions remain regarding both the definition of these mood switches and the most appropriate therapeutic strategy to avoid this adverse effect.

This review will first briefly consider the current guidelines for the acute treatment of bipolar depression. We will then review the mechanisms of action of antidepressant and mood stabilisers, and the switches induced by various types of antidepressant treatments, or triggered by antidepressant withdrawal, as well as by atypical antipsychotics. We then will address the risk of mood switch according to the type of mood stabiliser used. The propensity to mood switches in bipolar patients is subject to individual differences. Therefore we will describe both the clinical and biological characteristics of patients prone to mood switches under antidepressant treatment. However, the clinical characteristics of the depressive syndrome may also be a key determinant for mood switches. Various data help identify the most appropriate drug management strategies for avoiding mood switches during the treatment of bipolar depression. Selective serotonin reuptake inhibitors appear to be the drugs of first-choice because of the low associated risk of mood switching. Antidepressants must be associated with a mood stabiliser and the most effective in the prevention of switches seems to be lithium. Whatever the mood stabiliser used, effective plasma levels must be ensured. The optimal duration of antidepressant treatment for bipolar depression is still an open issue — prolonged treatments after recovery may be unnecessary and may facilitate mood elation. Moreover, some mood episodes with mixed symptoms can be worsened by antidepressants pointing to the need for a better delineation of the categories of symptoms requiring antidepressant treatment. Finally, as a result of this review, we suggest some propositions to define drug-induced switches in bipolar patients, and to try to delineate which strategies should be recommended in clinical practice to reduce as far as possible the risk of mood switch during the treatment of bipolar depression.

Keywords

Fluoxetine Lamotrigine Imipramine Venlafaxine Bupropion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This work was supported by INSERM and the Programme Hospitalier de Recherche Clinique, Délégation à la Recherche Clinique de l’Assistance Publique des Hopitaux de Paris (APHP) (PHRC AOM 98152). The authors have provided no information on conflicts of interest directly relevant to the content of this review.

References

  1. 1.
    Zornberg GL, Pope HG. Treatment of depression in bipolar disorder: new directions for research. J Clin Psychopharmacol 1993; 13(6): 397–408PubMedCrossRefGoogle Scholar
  2. 2.
    Prien RF, Rush AJ. National Institute of Mental Health Workshop report on the treatment of bipolar disorder. Biol Psychiatry 1996; 40: 215–20PubMedCrossRefGoogle Scholar
  3. 3.
    Ghaemi SN, Lenox MS, Baldessarini RJ. Effectiveness and safety of long-term antidepressant treatment in bipolar disorder. J Clin Psychiatry 2001; 62(7): 565–9PubMedCrossRefGoogle Scholar
  4. 4.
    Keller MB, Labori P, Coryell W, et al. Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. JAMA 1986; 255(3): 38–43Google Scholar
  5. 5.
    Goodwin FK, Jamison KF. Manic-depressive illness. New York: Oxford University Press, 1990Google Scholar
  6. 6.
    Frances AJ, Docherty JP, Kahn DA. The expert consensus guideline series: treatment of bipolar disorder. J Clin Psychiatry 1996, 57(Suppl 12A)Google Scholar
  7. 7.
    Frances AJ, Kahn DA, Carpenter D, et al. The expert consensus guidelines for treating depression in bipolar disorder. J Clin Psychiatry 1998; 59Suppl. 4: 73–9PubMedGoogle Scholar
  8. 8.
    American Psychiatric Association. Practice guideline for the treatment of patients with bipolar disorders. Am J Psychiatry 2002; 159 (4 Suppl.): 1–50Google Scholar
  9. 9.
    Alvarez JC, Gluk N, Arnulf I, et al. Decreased platelet serotonin transporteur sites and increased platelet inositol triphosphate levels in patients with unipolar depression: effects of clomipramine and fluoxetine. Clin Pharmacol Ther 1999; 66(6): 617–24PubMedGoogle Scholar
  10. 10.
    Wang HY, Markowitz P, Levinson D, et al. Increased membrane-associated protein kinase C activity and translocation in blood platelets from bipolar affective disorder patients. J Psychiatry Res 1999; 33(2): 171–9CrossRefGoogle Scholar
  11. 11.
    Chengappa KN, Levine J, Gershon S, et al. Inositol as an addon treatment for bipolar depression. Bipolar Disord 2000; 2(1): 47–55PubMedCrossRefGoogle Scholar
  12. 12.
    Williams RSB, Cheng L, Mudge W, et al. A common mechanism of action for three mood-stabilizing drugs. Nature 2002; 417: 292–5PubMedCrossRefGoogle Scholar
  13. 13.
    Manji HK, Zarate CA. Molecular and cellular mechanisms underlying mood stabilization in bipolar disorder: implications for the development of improved therapeutics. Mol Psychiatry 2002; 7(1): 1–7CrossRefGoogle Scholar
  14. 14.
    Chang DM, Chen RW, Chalecka-Franaszek E, et al. Neuroprotective effects of lithium in cultured cells and animal models of diseases. Bipolar Disord 2002; 4(2): 129–36CrossRefGoogle Scholar
  15. 15.
    Bunney WE. Psychopharmacology of the switch process in affective illness. In: Lipton M, Dimascio A, Killiam K, editors. Psychopharmacology: a generation of progress. New York: Raven Press, 1978: 1249–59Google Scholar
  16. 16.
    Prien RF, Klett J, Caffey EM, et al. Lithium carbonate and imipramine in prevention of affective episodes. Arch Gen Psychiatry 1973; 29: 420–5PubMedCrossRefGoogle Scholar
  17. 17.
    Prien RF, Kupfer DJ, Mansky PA, et al. Drug therapy in the prevention of recurrences in unipolar and bipolar affective disorders. Arch Gen Psychiatry 1984; 41: 1096–104PubMedCrossRefGoogle Scholar
  18. 18.
    Akiskal HS, Djenderedjian AH, Rosenthal RH, et al. Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. Am J Psychiatry 1977; 134: 1227–3PubMedGoogle Scholar
  19. 19.
    Wehr TA, Goodwin FK. Rapid cycling in manic-depressives induced by tricyclic antidepressants. Arch Gen Psychiatry 1979; 36: 555–9PubMedCrossRefGoogle Scholar
  20. 20.
    Lewis JL, Winokur G. The induction of mania: a natural history study with controls. Arch Gen Psychiatry 1982; 39: 303–6PubMedCrossRefGoogle Scholar
  21. 21.
    Altshuler LL, Post RM, Leverich GS, et al. Antidepressant-induced mania and cycle acceleration: a controversy revisited. Am J Psychiatry 1995; 152(8): 1130–8PubMedGoogle Scholar
  22. 22.
    Peet M. Induction of mania with selective serotonin re-uptake inhibitors and tricyclic antidepressants. Br J Psychiatry 1994; 164(4): 549–50PubMedCrossRefGoogle Scholar
  23. 23.
    Boerlin HL, Gitlin MJ, Zoellner LA, et al. Bipolar depression and antidepressant-induced mania: a naturalistic study. J Clin Psychiatry 1998; 59: 374–9PubMedCrossRefGoogle Scholar
  24. 24.
    Simpson SG, DePaulo JR. Fluoxetine treatment of bipolar II depression. J Clin Psychopharmacol 1991; 11(1): 52–4PubMedCrossRefGoogle Scholar
  25. 25.
    Howland RH. Induction of mania with serotonin reuptake inhibitors. J Clin Psychopharmacol 1996; 16: 425–7PubMedCrossRefGoogle Scholar
  26. 26.
    Cohn JB, Collins G, Ashbrook E, et al. A comparison of fluoxetine, imipramine and placebo in patients with bipolar depressive disorder. Int Clin Psychopharmacol 1989; 4(4): 313–22PubMedCrossRefGoogle Scholar
  27. 27.
    Young ML. A double-blind placebo-controlled trial comparing the effect of paroxetine and imipramine in the treatment of bipolar depression. 2nd International Conference on Bipolar Disorders; 1997 Jun 19-21; Pittsburg (PA)Google Scholar
  28. 28.
    Young LT, Joffe RT, Robb JC, et al. Double-blind comparison of addition of a second mood stabilizer versus an antidepressant to an initial mood stabilizer for treatment of patients with bipolar depression. Am J Psychiatry 2000; 157(1): 124–6PubMedGoogle Scholar
  29. 29.
    Amsterdam JD, Garcia-Espana F, Fawcett J, et al. Efficacy and safety of fluoxetine in treating bipolar II major depressive episode. J Clin Psychopharmacol 1998; 18(6): 435–40PubMedCrossRefGoogle Scholar
  30. 30.
    Henry C, Sorbara F, Lacoste J, et al. Antidepressant-induced mania in bipolar patients: identification of risk factors. J Clin Psychiatry 2001; 62: 249–55PubMedCrossRefGoogle Scholar
  31. 31.
    American Psychiatric Association. DSM-IV. Diagnostic and statistical manual of mental disorders (4th edition). Washington, DC: APA, 1994Google Scholar
  32. 32.
    Sachs GS, Thase M. Bipolar disorder. Therapeutics: maintenance treatment. Biol Psychiatry 2000; 48: 573–81PubMedCrossRefGoogle Scholar
  33. 33.
    Himmelhoch JM, Thase ME, Mallinger AG, et al. Tranylpromine versus imipramine in anergic bipolar depression. Am J Psychiatry 1991; 148(7): 910–6PubMedGoogle Scholar
  34. 34.
    Angst J, Stable M. Efficacy of moclobemide in different patient groups: a meta-analysis of studies. Psychopharmacology 1992; 106: 109–13CrossRefGoogle Scholar
  35. 35.
    Stoll AL, Mayer PV, Kolbrener M, et al. Antidepressant-associated mania: a controlled comparison with spontaneous mania. Am J Psychiatry 1994; 151: 1642–4645PubMedGoogle Scholar
  36. 36.
    Silverstone T. Moclobemide vs imipramine in bipolar depression: a multicentre double-blind clinical trial. Acta Psychiatr Scand 2001; 104(2): 104–9PubMedCrossRefGoogle Scholar
  37. 37.
    Sachs GS. Teatment-resistant bipolar depression. Psychiatr Clin North Am 1996; 19: 215–36PubMedCrossRefGoogle Scholar
  38. 38.
    Beasley CM, Masica DN, Heiligenstein JH, et al. Possible monoamine oxidase inhibitor-serotonin reuptake inhibitor interaction: fluoxetine clinical data and preclinical findings. J Clin Psychopharmacol 1993; 13: 312–20PubMedCrossRefGoogle Scholar
  39. 39.
    Shopsin B. Bupropion’s prophylactic efficacy in bipolar affective illness. J Clin Psychiatry 1983; 44: 163–9PubMedGoogle Scholar
  40. 40.
    Haykel RF, Akiskal HS. Bupropion as a promosing approach to rapid cycling bipolar II patients. J Clin Psychiatry 1990; 51: 450–5Google Scholar
  41. 41.
    Sachs GS, Lafer B, Stoll A, et al. A double-blind trial of bupropion versus desipramine for bipolar depression. J Clin Psychiatry 1994; 55(9): 391–3PubMedGoogle Scholar
  42. 42.
    Fogelson DL, Bystritsky A, Pasnau R. Bupropion in the treatment of bipolar disorders: the same old story? J Clin Psychiatry 1992; 53: 443–6PubMedGoogle Scholar
  43. 43.
    Grossman F, Potter WZ, Brown EA, et al. A double-blind study comparing idazoxan and bupropion in bipolar depressed patients. J Affect Disord 1999 Dec; 56(2-3): 237–43PubMedCrossRefGoogle Scholar
  44. 44.
    Erfurth A, Michael N, Stadtland C, et al. Bupropion as add-on strategy in difficult-to-treat bipolar depressive patients. Neuropsychobiology 2002; 45Suppl. 1: 33–6PubMedCrossRefGoogle Scholar
  45. 45.
    Thase ME, Sachs GS. Bipolar depression: pharmacotherapy and related therapeutic stategies. Biol Psychiatry 2000; 48: 558–72PubMedCrossRefGoogle Scholar
  46. 46.
    Amsterdam J. Efficacy and safety of venlafaxine in the treatment of bipolar II major depressive episode. J Clin Psychopharmacol 1998 Oct; 18(5): 414–7PubMedCrossRefGoogle Scholar
  47. 47.
    Stoner SC, William RJ, Worrel J, et al. Possible venlafaxine-induced mania. J Clin Psychopharmacol 1999; 19(2): 184–5PubMedCrossRefGoogle Scholar
  48. 48.
    Shulman RB, Scheftner WA, Nayudu S. Venlafaxine-associated mania. J Clin Psychopharmacol 2001; 21(2): 239–41PubMedCrossRefGoogle Scholar
  49. 49.
    Vieta E, Martinez-Aran A, Goikolea JM, et al. A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry 2002; 63–6: 508-12Google Scholar
  50. 50.
    Sachs GS, Printz DJ, Kahn DA, et al. The Expert Consensus Guideline Series: medication treatment of bipolar disorder. Postgrad Med 2000 Apr; Special edition: 1–104Google Scholar
  51. 51.
    Angst J, Angst K, Baruffol IK, et al. ECT-induced and drug-induced hypomania. Convuls Ther 1992; 8: 179–85PubMedGoogle Scholar
  52. 52.
    Gabbay V, O’Dowd MA, Asnis GM. Combined antidepressant treatment: a risk factor for switching [letter]. J Clin Psychiatry 2002; 63(4): 367PubMedCrossRefGoogle Scholar
  53. 53.
    Zubieta JK. Possible bupropion precipitation of mania and a mixed affective state. J Clin Psychopharmacol 1991; 11: 327–8PubMedCrossRefGoogle Scholar
  54. 54.
    Goldstein TR, Frye MA, Denicoff KD, et al. Antidepressant discontinuation-related mania: critical prospective observation and theoretical implications in bipolar disorder. J Clin Psychiatry 1999; 60(8): 563–7PubMedCrossRefGoogle Scholar
  55. 55.
    Mirin SM, Schatzberg AF, Creasey DE. Hypomania and mania after withdrawal of tricyclic antidepressants. Am J Psychiatry 1981; 138: 87–9PubMedGoogle Scholar
  56. 56.
    Nelson JC, Schottenfield RS, Conrad ED. Hypomania after desipramine withdrawal. Am J Psychiatry 1983; 140: 624–5PubMedGoogle Scholar
  57. 57.
    Dilsaver SC. Antidepressant withdrawal syndromes: phenomenology and pathophysiology. Acta Psychiatr Scand 1989; 79: 113–7PubMedCrossRefGoogle Scholar
  58. 58.
    Henry C. SSRIs and induction of manic episode. J Clin Psychiatry 2002; 63(4): 367–8CrossRefGoogle Scholar
  59. 59.
    Tran PV, Dellva MA, Toffelson GD, et al. Extrapyramidal symptoms and tolerability of olanzapine versus haloperidol in the acute treatment of schizophrenia. J Clin Psychiatry 1997; 58: 205–11PubMedCrossRefGoogle Scholar
  60. 60.
    Miller CH, Mohr F, Umbrich D, et al. The prevalence of acute extrapyramidal signs and symptoms in patients treated with clozapine, risperdone, and conventional antipsychotics. J Clin Psychiatry 1998; 59: 69–75PubMedCrossRefGoogle Scholar
  61. 61.
    Ghaemi SN, Sachs GS. Long term risperidone treatment in bipolar disorder: 6 month follow up. Int Clin Psychopharmacol 1997; 12: 333–8PubMedCrossRefGoogle Scholar
  62. 62.
    Keck Jr PE, McElroy SL, Strakowski SM. Anticonvulsant and antipsychotics in the treatment of bipolar disorder. J Clin Psychiatry 1998; 59: 74–81PubMedGoogle Scholar
  63. 63.
    Suppes T, Webb A, Paul B, et al. Clinical outcomes in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. Am J Psychiatry 1999; 156: 1164–9PubMedGoogle Scholar
  64. 64.
    Tohen M, Sanger TM, McElroy SL, et al. Olanzapine versus placabo in the treatment of acute mania. Am J Psychiatry 1999; 156: 702–9PubMedGoogle Scholar
  65. 65.
    Tohen M, Jacobs T, Grundy SL, et al. Efficacy of olanzapine in acute bipolar mania: a double-blind, placebo-controlled study. Arch Gen Psychiatry 2000; 57: 841–9PubMedCrossRefGoogle Scholar
  66. 66.
    Aubry JM, Simon AE, Bertschy G. Possible induction of mania and hypomania by olanzapine or risperidone: a critical review of reported cases. J Clin Psychiatry 2000; 61(9): 649–55PubMedCrossRefGoogle Scholar
  67. 67.
    Henry C, Demotes-Mainard J. Olanzapine-induced mania in bipolar disorders. J Psychiatry Neurosci 2002; 27(3): 200–1PubMedGoogle Scholar
  68. 68.
    Lane HY, Lin YC, Chang WH. Mania induced by risperidone: dose related? J Clin Psychiatry 1998; 59: 85–6PubMedCrossRefGoogle Scholar
  69. 69.
    Ichikawa J, Ishii H, Bonaccorso S, et al. 5-HT2A and D2 receptor blockade increases cortical DA release via 5HT1A receptor activation: a possible mechanism of atypical antipsychotic-induced cortical dopamine release. J Neurochem 2001; 76(5): 1521–31PubMedCrossRefGoogle Scholar
  70. 70.
    Tohen M. Antidepressant effects of atypical antipsychotics. EU Bipolar Regional Neuroscience Conference; 2002 Sep 9-10; Geneva, SwitzerlandGoogle Scholar
  71. 71.
    Pilla M, Perachon S, Sautel F, et al. Selective inhibition of cocaine-seeking behaviour by a partial dopamine D3 receptor agonist. Nature 1999; 400(6742): 371–5PubMedCrossRefGoogle Scholar
  72. 72.
    Bellivier F, Henry C, Schurhof F, et al. Study of two polymorphisms of the serotonin transporter gene in unipolar and bipolar patients. Neurosci Lett 1998; 255(3): 243–6CrossRefGoogle Scholar
  73. 73.
    Jann MW, Bitar AJ, Rao A. Lithium prophylaxis of tricyclic-antidepressant-induced mania in bipolar patients. Am J Psychiatry 1982; 139: 683–4PubMedGoogle Scholar
  74. 74.
    Lewis JL, Winokur G. The induction of mania: a natural history study with controls. Arch Gen Psychiatry 1982; 39: 303–6PubMedCrossRefGoogle Scholar
  75. 75.
    Rouillon F, Lejoyeux M, Filteau MJ. Unwanted effects of long term treatment. In: Montgomery SA, Rouillon FA, editors. Long-term treatment of depression. New York (NY): John Wiley & Sons, 1992: 81–111Google Scholar
  76. 76.
    Bottlender R, Rudolf D, Stauss A, et al. Mood-stabilisers reduce the risk of developing antidepressant-induced maniform states in acute treatment of bipolar I depressed patients. J Affect Disord 2001; 63: 79–83PubMedCrossRefGoogle Scholar
  77. 77.
    Davis LL, Kabel D, Patel D, et al. Valproate as an antidepressant in major depressive disorder. Psychopharmacol Bull 1996; 32: 647–52PubMedGoogle Scholar
  78. 78.
    Post RM. Mood disorders: treatment of bipolar disorders. In Sadock BJ, Sadock VA, editors. Kaplan & Sadock’s comprehensive texbook of psychiatry. 7th ed. New York: William & Wilkins, 2000: 1385–1430Google Scholar
  79. 79.
    Stoner SC, Worrel JA, Vlach D, et al. Retrospective analysis of serum valproate levels and need for an antidepressant drug. Pharmacotherapy 2001; 21(7): 850–4PubMedCrossRefGoogle Scholar
  80. 80.
    Bowden CL, Calabrese JR, McElroy SL, et al. The efficacy of lamatrigine in rapid cycling and non-rapid cycling patients with bipolar disorder. Biol Psychiatry 1999; 45: 953–8PubMedCrossRefGoogle Scholar
  81. 81.
    Calabrese JR, Bowden CL, Sachs GS, et al. A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group. J Clin Psychiatry 1999; 60: 79–88PubMedCrossRefGoogle Scholar
  82. 82.
    Messenheimer J, Mullens EL, Giorgi L, et al. Safety review of adult clinical trial experience with lamotrigine. Drug Saf 1998; 18(4): 281–96PubMedCrossRefGoogle Scholar
  83. 83.
    Henry C, Lacoste J, Bellivier F, et al. Temperament in bipolar illness: impact on prognosis. J Affect Disord 1999; 56: 103–8PubMedCrossRefGoogle Scholar
  84. 84.
    MacQueen GM, Young LT, Marriott M, et al. Previous mood state predicts response and switch rates in patients with bipolar depression. Acta Psychiatr Scand 2002; 105: 414–8PubMedCrossRefGoogle Scholar
  85. 85.
    Bottlender R, Rudolf D, Strauss A, et al. Are low basal serum levels of the thyroid stimulating hormone (b-TSH) a risk factor for switches into states of expansive syndromes (known in Germany as ‘manoform syndromes’ in bipolar I depression? Pharmacopsychiatry 2000; 33(2): 75–7PubMedCrossRefGoogle Scholar
  86. 86.
    Mundo E, Walker M, Cate T, et al. The role of serotonin transporter protein gene in antidepressant-induced mania in bipolar disorder: preliminary findings. Arch Gen Psychiatry 2001; 58: 539–44PubMedCrossRefGoogle Scholar
  87. 87.
    Bellivier F, Rousseva A, Henry C, et al. Antidepressant-induced mania, rapid cycling and the serotonin transporter gene polymorphism. Pharmacogenomics J. In pressGoogle Scholar
  88. 88.
    Koukopoulos A, Koukopoulos A. Bipolarity: beyond classic mania. Agitated depression as a mixed state and the problem of melancholia. Psychiatr Clin North Am 1999; 22: 547–62PubMedCrossRefGoogle Scholar
  89. 89.
    Henry C. Why are some depressions worsened by antidepressants? [abstract]. The International Society for Affective Disorders; 2002 Mar 9-12; Taormina, SicilyGoogle Scholar
  90. 90.
    Bottlender R, Sato T, Kleindienst N, et al. Mixed depressive features predict maniform switch during depression treatment in bipolar I disorder. J Affect Disord. In pressGoogle Scholar
  91. 91.
    Calabrese JR, Rapport DJ, Kimmel SE, et al. Controlled trials in bipolar I depression: focus on switch rates and efficacy. Eur Neuropsychopharmacol 1999; 9(4): 109–12CrossRefGoogle Scholar
  92. 92.
    Nasrallah HA, Lyskowksi J, Schroeder D. TCA-induced mania: differences between switchers and nonswitchers. Biol Psychiatry 1982; 17(2): 271–4PubMedGoogle Scholar
  93. 93.
    Post RM, Altshuler LL, Frye MA, et al. Rate of switch in bipolar patients prospectively treated with second-generation antidepressants as augmentation to mood stabilizers. Bipolar Disord 2001; 3(5): 259–65PubMedCrossRefGoogle Scholar
  94. 94.
    Sachs GS, Thase M. Bipolar disorder therapeutics: maintenance treatment. Biol Psychiatry 2000; 48: 573–81PubMedCrossRefGoogle Scholar
  95. 95.
    Moller HJ, Grunze H. Have some guidelines for the treatment of acute bipolar depression gone too far in the restriction of antidepressants? Eur Arch Psychiatry Clin Neurosci 2000; 250(2): 57–68PubMedCrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Service Universitaire de Psychiatrie, CH Charles PerrensBordeauxFrance
  2. 2.Neurobiologie Intégrative, Institut François MagendieBordeauxFrance
  3. 3.Centre d’Investigation Clinique, INSERM-CHU de BordeauxBordeauxFrance

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