Manic conversion

Antidepressant-Induced Manic Conversion A Developmentally Informed Synthesis of the Literature... 

Martin et al. (2004) used an administrative national database of more than 7 million privately insured individuals, aged 5-29 years, to find new diagnoses of bipolar illness made in association with antidepressant treatment. They found a statistically significant correlation between exposure to all categories of antidepressants and the subsequent diagnosis of bipolar disorder. During a median follow-up of 41 weeks, manic conversion occurred in 5.4% of patients. The highest risk was... 

Manic Conversion (Switching) in Adult Bipolar Patients... 

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 ... 

Martin, A., Young, C., Leckman, J., Mukonoweshuro, C., Rosenheck, R., Leslie, D. (2004). Age effects on antidepressant-induced manic conversion. Archives of Pediatric and Adolescent Medicine, 158, 773-780. 

Flight of ideas and pressured speech can make it hard to follow manic conversations. If Josie s irritated by your inability to keep up, try appealing to her grandiosity, e.g. I think I m a little slow, compared with youl/I m a bit out of my depth here. Could you explain that again, slowly ... 

At the time of this publication, only one case of a manic adolescent being responsive to gabapentin for the treatment of mania has been reported (Soutullo et al., 1998). Conversely, several cases of aggressive behavior associated with gabapentin in children with seizures have been reported (Wolf et al., 1995, Khurana... 

Specific factors to consider are both psychiatric and physical contraindications. For example, bupropion is contraindicated in a depressed patient with a history of seizures due to the increased risk of recurrence while on this agent. Conversely, it may be an appropriate choice for a bipolar disorder with intermittent depressive episodes that is otherwise under good control with standard mood stabilizers. This consideration is based on the limited data suggesting that bupropion is less likely to induce a manic switch in comparison with standard heterocyclic antidepressants. Another example is the avoidance of benzodiazepines for the treatment of panic disorder in a patient with a history of alcohol or sedative-hypnotic abuse due to the increased risk of misuse or dependency. In this situation, a selective serotonin reuptake inhibitor (SSRI) may be more appropriate. 

Conversely, patients may also display certain interpersonal styles that fluctuate with the course of their illness. For example, Janowsky et al. ( 40) demonstrated that manic patients have a characteristic interactional style that clearly distinguishes them from schizoaffective and schizophrenic patients. Using their Manic Interpersonal Interaction Scale (MIIS) to assess changes in personality style, the authors found manic patients more likely to do the following ... 

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