Mania from SSRIs

In general, the pattern of adverse reactions is similar among all the SSRIs and some of the other new antidepressants that block the reuptake of serotonin, especially venlafaxine. As a result, the FDA has required class label warnings for them in regard to suicidality and to the array of stimulant adverse reactions, from agitation and hostility to mania. 

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. ... 

Two young women with metamfetamine abstinence developed mania after taking fluvoxamine, which was prescribed for persistent depressive symptoms (32). Both had abused metamphetamine for several years. Two weeks after starting to take fluvoxamine 100 mg/day and brotizolam 0.5 mg/day they became manic, with elevated mood, talkativeness, and increased activity. When fluvoxamine was withdrawn the manic state gradually abated and they were discharged from hospital 3 months after admission. It is not known whether a manic switch in metamfetamine users with depression is specific to fluvoxamine, or can occur with other SSRIs. 

Another risk of antidepressants in vulnerable patients (particularly those with unrecognized bipolar depression) is switching, sometimes suddenly, from depression to hypomanic or manic excitement, or mixed, dysphoric-agitated, manic-depressive states. To some extent this effect is dose-related and is somewhat more likely in adults treated with tricyclic antidepressants than with SSRIs, bupropion, and perhaps with MAO inhibitors. Risk of mania with newer sedating antidepressants, including nefazodone and mirtazapine, also may be relatively low, but some risk of inducing mania can be expected with any treatment that elevates mood. 

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