Antidepressant-Induced Mania in Bipolar Patients: Identification of Risk Factors
J Clin Psychiatry 2001;62(4):249-255
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Concerns about possible risks of
switching to mania associated with antidepressants continue to
interfere with the establishment of an optimal treatment paradigm
for bipolar depression.
Method: The response of 44 patients meeting
DSM-IV criteria for bipolar disorder to naturalistic treatment
was assessed for at least 6 weeks using the Montgomery-Asberg
Depression Rating Scale and the Bech-Rafaelson Mania Rating
Scale. Patients who experienced a manic or hypomanic switch were
compared with those who did not on several variables including
age, sex, diagnosis (DSM-IV bipolar I vs. bipolar II), number of
previous manic episodes, type of antidepressant therapy used
(electroconvulsive therapy vs. antidepressant drugs and, more
particularly, selective serotonin reuptake inhibitors [SSRIs]),
use and type of mood stabilizers (lithium vs. anticonvulsants),
and temperament of the patient, assessed during a normothymic
period using the hyperthymia component of the Semistructured
Affective Temperament Interview.
Results: Switches to hypomania or mania occurred
in 27% of all patients (N = 12) (and in 24% of the subgroup of
patients treated with SSRIs [8/33]); 16% (N = 7) experienced
manic episodes, and 11% (N = 5) experienced hypomanic episodes.
Sex, age, diagnosis (bipolar I vs. bipolar II), and additional
treatment did not affect the risk of switching. The incidence of
mood switches seemed not to differ between patients receiving an
anticonvulsant and those receiving no mood stabilizer. In
contrast, mood switches were less frequent in patients receiving
lithium (15%, 4/26) than in patients not treated with lithium
(44%, 8/18; p = .04). The number of previous manic episodes did
not affect the probability of switching, whereas a high score on
the hyperthymia component of the Semistructured Affective
Temperament Interview was associated with a greater risk of
switching (p = .008).
Conclusion: The frequency of mood switching
associated with acute antidepressant therapy may be reduced by
lithium treatment. Particular attention should be paid to
patients with a hyperthymic temperament, who have a greater risk
of mood switches.