Antidepressant-associated mania with escitalopram

Abstract

appeared when the diuretic was withheld. The treatment strategy was then changed to taper the dosage of amusulpride from 800 to 400 mg per day and to stop using the diuretic. Within one week with this strategy, the bilateral pedal edema resolved entirely. The patient's psychiatric condition remained stable on this dosage of amisulpride. In our case, treatment of amisulpride alone or an adverse interaction between amisulpride and lorazepam may be responsible for the patient's bilateral pedal edema. The latter is less likely because amisulpride and lorazepam have not been reported to have significant pharmacokinetic interaction. In addition, amisulpride appeared to be associated with the patient's pedal edema in a dose-related fashion since the pedal edema disappeared after prescribing a lower dosage of amisulpride. The finding of elevated IgE with normal values of C3 and C4 was similar to a previous report regarding risperidone-associated allergic reaction [4]. In that report, the authors suggested that the allergic reaction in their case might be type I or type IV allergic reaction since IgE level was elevated and C3/C4 levels were within normal limits. It suggests that the pathogenesis of pedal edema in both cases might be caused by a similar mechanism. However, the pathophysiological mechanism of amisulpride-associated pedal edema is still not clear as of edema associated with other new antipsychotic agents. It is subject to further clinical investigation and research concerning this issue.

Severe Manic Episode Associated With Tramadol in a Patient With Recurrent Depressive Disorder

“…10 Cases of mania have been reported under escitalopram therapy in patients with no history of mania. 11,12 In the present case, because the patient had taken escitalopram for 6 months, the risk for a switch to mania was decreased but remained still possible, particularly in the absence of a mood stabilizer. Of note, the patient was previously treated with the antidepressant fluoxetine for at least 2 years without a manic switch.…”

Dosage-related nature of escitalopram treatment-emergent mania/hypomania: a case series

“…Although it is also considered to have fewer adverse effects than other SSRIs, 42 , 43 escitalopram-induced mania/hypomania has been documented in a few case reports and in one clinical trial. 32 – 34 Historically, the rate of SSRI treatment-emergent mania has been estimated at 3%–6% in bipolar depression and less than 3% in major depressive disorder. 5 , 6 , 44 Previous studies have identified several risk factors for antidepressant-induced manic switch, such as signs of bipolarity and family history of bipolar disorder.…”

“…Among SSRIs, escitalopram possesses the greatest serotonin transporter (5-HTT) selectivity, 29 with fewer adverse effects than other SSRIs. 30 , 31 While treatment-emergent mania/hypomania has been reported in a few clinical cases and one clinical trial, 32 – 34 it remains unknown whether this effect is dose-related.…”