Conversion Switching in Adult Bipolar Patients

Manic Conversion (Switching) in Adult Bipolar Patients 

There are many studies of patients diagnosed with bipolar disorder converting from depression to mania when being treated with antidepressants. The rates are astonishingly high, contradicting the common practice of giving antidepressants to patients who have had previous hypomanic or manic episodes. 

Henry et al. (2001) followed 44 patients meeting DSM-IV criteria for bipolar disorder. They found that switches from hypomania to mania occurred in 24% of patients treated with SSRIs. Most (16%) had frank manic episodes. Goldberg and Truman (2003) reviewed the literature and found that about 20% to 40% of bipolar patients were converted into manic states by antidepressants of all classes. They concluded, About one quarter to one-third of bipolar patients may be inherently susceptible to antidepressant induced manias.  

Bipolar patients with so-called breakthrough major depressive episodes, despite adequate treatment, were placed in a randomized doubleblind 10-week study and treated with bupropion, sertraline, or venlafaxine augmentation (Post et al., 2001). Switches to hypomania or mania occurred in 14% of the patients. Those who responded positively to the treatment were continued for 1 year in a blinded maintenance trial, and 33% switched into hypomania or mania. In a second phase of their antidepressant augmentation studies, 18.2% switched into hypomania or 

Ghaemi et al. (2002), who reviewed 85 charts of outpatients with affective disorder seen in a clinic, concluded that 37% had an undiagnosed bipolar disorder and that 23% of them had developed a new or worsening rapid-cycling course attributable to antidepressant use. They concluded, Antidepressants seem to be associated with a worsened course of bipolar illness. Ghaemi et al. (2003) reviewed the literature and looked further into the issue of manic conversion. They drew the following conclusions  

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