Sleep-Related Hypomanic Symptoms as a Predictor of Bipolar Spectrum Disorders

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Sir: Deciding whether to prescribe antidepressants for the depressed patients with bipolar spectrum disorders remains a challenge for clinicians. Two most-feared potential consequences of using antidepressants in patients with bipolar spectrum disorders are triggering a manic switch and/or generating a rapid cycling course of the disease.1 Experts have long tried to recognize the depressed patients who are at a greater risk for switching to mania; thus, several symptoms have been suggested as “soft signs” of bipolarity, including hypersomnia, psychomotor retardation, young age at onset of depression, family history of bipolar disorder, drug-induced hypomania, seasonality of the episodes, and diurnal variation of the symptoms.2​

Prim Care Companion J Clin Psychiatry 2007;9(3):233-234 [letter]