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The term “antidepressant-induced mania” is confusing because it has been used in the published literature to refer to several different situations. It has been used to refer to mania or hypomania that developed soon after an antidepressant was started in a person with:
– Bipolar disorder
– Unipolar depressive disorder
– Another mental disorder (e.g., OCD) but no previous mood disorder (for example, Berk et al., 1996; Vieta and Bernardo, 1992; Steiner, 1991).
On this page, we are asking—What are the risk factors for antidepressant-induced mania or hypomania in a person who is NOT known to have bipolar disorder?
A database study found the following factors to predict a higher chance of patients with unipolar depression developing a manic episode after being started on an antidepressant (Martin et al., 2004):
– Use of a tricyclic antidepressant (about twice the risk of inducing a manic switch compared to SSRIs)
– Peripubertal children (10 to 14 years old) given an antidepressant
Mania/ hypomania after stopping an antidepressant
Mania can also occur after an antidepressant is stopped—in persons with either bipolar disorder or unipolar depression (Kwok and Lim, 2017; Ali and Milev, 2003).
What is antidepressant-induced mania or hypomania?
5-HTTLPR and antidepressant-induced mania
Ali S, Milev R. Switch to mania upon discontinuation of antidepressants in patients with mood disorders: a review of the literature. Can J Psychiatry. 2003 May;48(4):258-64. doi: 10.1177/070674370304800410. PMID: 12776393.
Amey C. Suspected antidepressant-induced switch to mania in unipolar depression: a first-person narrative. J Affect Disord. 2010 Sep;125(1-3):111-5. doi: 10.1016/j.jad.2010.05.004. Epub 2010 Jun 8. PMID: 20570368.
Berk M, Koopowitz LF, Szabo CP. Antidepressant induced mania in obsessive compulsive disorder. Eur Neuropsychopharmacol. 1996 Mar;6(1):9-11. doi: 10.1016/0924-977x(95)00046-r. PMID: 8866932.
Jagadheesan K, Sandil R, Ram D. Venlafaxine-induced mania. Indian J Psychiatry. 2001 Oct;43(4):357-9. PMID: 21407889; PMCID: PMC2956250.
Kwok CSN, Lim LEC. Mania following antidepressant discontinuation in depression: two case reports. Australas Psychiatry. 2017 Dec;25(6):617-621. doi: 10.1177/1039856217732470. Epub 2017 Oct 4. PMID: 28976215.
Martin A, Young C, Leckman JF, Mukonoweshuro C, Rosenheck R, Leslie D. Age effects on antidepressant-induced manic conversion. Arch Pediatr Adolesc Med. 2004 Aug;158(8):773-80. doi: 10.1001/archpedi.158.8.773. PMID: 15289250.
Philip J, Janaki R. Antidepressant-induced mania in obsessive compulsive disorder. Indian J Psychiatry. 2012 Apr;54(2):194-5. doi: 10.4103/0019-5545.99543. PMID: 22988331; PMCID: PMC3440918. Case report; OCD and depression; switched to mania after 20 years of treatment.
Scott J, Brichant-Petitjean C, Etain B, Henry C, Kahn JP, Azorin JM, Leboyer M, Bellivier F. A re-examination of antidepressant treatment-emergent mania in bipolar disorders: evidence of gender differences. Acta Psychiatr Scand. 2017 May;135(5):479-488. doi: 10.1111/acps.12728. Epub 2017 Apr 1. PMID: 28369709.
Steiner W. Fluoxetine-induced mania in a patient with obsessive-compulsive disorder. Am J Psychiatry. 1991 Oct;148(10):1403-4. doi: 10.1176/ajp.148.10.1403b. PMID: 1897626.
Vieta E, Bernardo M. Antidepressant-induced mania in obsessive-compulsive disorder. Am J Psychiatry. 1992 Sep;149(9):1282-3. doi: 10.1176/ajp.149.9.aj14991282. PMID: 1503154.
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