Mania antidepressants triggering switch into

There is, however, a unique risk in the bipolar form that antidepressant treatment may trigger a switch into mania. This may occur either as the natural outcome of recovery from depression or as a pharmacological effect of the drug. Particular antidepressants (the selective serotonin reuptake inhibitors) seem less liable to induce the switch into mania than other antidepressants or electroconvulsive therapy. Treatment for mania consists initially of antipsychotic medication, for instance the widely used haloperidol, often combined with other less specific sedative medication such as the benzodiazepines (lorazepam intramuscularly or diazepam orally). The manic state will usually begin to subside within hours and this improvement develops further over the next 2 weeks. If the patient remains disturbed with manic symptoms, additional treatment with a mood stabilizer may help. 

More controversial is the occurrence of antidepressant-induced mania or hypo-mania. DSM-IV specifically states that manic or hypomanic episodes triggered by antidepressant treatment should not count toward the diagnosis of BPAD. However, clinicians have traditionally viewed antidepressant-induced switching from depression into mania as an unmasking of a preexisting BPAD that had previously been unrecognized and undiagnosed. 

For the patient with persistent depressive symptoms, antidepressants are often necessary. However, the possibility of triggering a "switch" into mania must always be considered. Attempts have been made to develop reliable recommendations for the predictive risk of antidepressant-induced mania or hypomania (Kupfer, Carpenter, and Frank 1988, Altshuler et al. 1995). Stoll and colleagues (1994) report less risk with monoamine oxidase inhibitors or bupropion than with tricyclics or serotonin specific antidepressants. Due to lack of controlled studies and heterogeneous data sources, this issue remains controversial and is far from resolved. 

Mania is listed as a possible adverse effect of all antidepressant drugs, and there is a well recognized association between the use of antidepressants and reports of switches from depression into mania (SEDA-23, 17). There are three kinds of explanation for this phenomenon (i) a spontaneous switch from depression into mania as part of a bipolar illness, which happens by chance to coincide with the use of antidepressant treatment (ii) the mania is indeed triggered by the antidepressant drug but the depression is part of a bipolar illness and bipolar patients are unusually susceptible to antidepressant-induced hypomania (iii) antidepressants can induce mania in patients with true unipolar depression who would never otherwise suffer from manic illness. 

---

See also in sourсe #XX -- [ ]

---