Development of mania in close association with tricyclic antidepressant administration in Children. A report of two cases

Abstract

Two depressed children with a strong family history of affective disorder developed manic episodes shortly after starting treatment with low dose antidepressant therapy. In one of these cases manic symptoms appeared on each of the three occasions that tricyclic medication was started or increased in dosage. There are a few reports of manic switching in young people and one that describe such a close temporal association between the administration of antidepressants and the development of mania. Children with a family history of affective disorder may be more susceptible to manic switching.

Rates and Predictors of Developing a Manic or Hypomanic Episode 1 to 2 Years Following a First Hospitalization for Major Depression with Psychotic Features

“…Indeed, several other investigators have reported the induction of mania following initiation of tricyclic antidepressants in children 174 DELBELLO ET AL. and adolescents with major depression (Briscoe et al 1995;Strober 1998). However, less is known about the effects of selective serotonin reuptake inhibitors (Stoll et al 1994).…”

Symptoms Leading to a Bipolar Diagnosis: A Phone Survey of Child and Adolescent Psychiatrists

“…Research shows that patients who receive accurate diagnoses are discharged from hospitals more quickly (Miller 2001) and that when psychiatrists are given accurate diagnoses for their patients, they may change their treatment plans (Basco 2000). If clinicians miss the diagnosis of BPD, they may risk triggering manic episodes by treating with antidepressant or stimulant medication (Strober and Carlson 1982;Brisoce et al 1995;Strober 1998;Reichart and Nolen 2004), although, in their review of the literature, Licht and colleagues (2008) failed to find evidence of iatrogenic mood effects with selective serotonin reuptake inhibitors (SSRIs). Similarly, if clinicians diagnose BPD where instead a child has another disorder, such as attention-deficit=hyperactivity disorder (ADHD), ADHD with subthreshold manic symptoms, anxiety disorders, or depression, the child and adolescent psychiatrists (CAP) might prescribe unnecessary medication (such as a mood stabilizer or atypical antipsychotic) and fail to prescribe appropriate medication for the correct diagnosis.…”