Manic/Hypomanic Switch During Acute Antidepressant Treatment for Unipolar Depression

Abstract

A significant proportion of patients with unipolar depression clinically develop manic or hypomanic switch during acute antidepressant treatment. Elucidation of its prevalence and predicting factors is of clinical relevance during acute antidepressant treatment of such patients. We retrospectively studied patients with unipolar depression who were admitted to our department during the 6-year period from 1997 to 2002 and who had fewer than 3 previous episodes before admission. The clinical background of the consecutive patients with manic/hypomanic switch (n = 37) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria was compared with that of patients without manic/hypomanic switch (n = 245). The prevalence rate of manic/hypomanic switch was 13.1%. The switch group was composed of 23 men and 14 women, whose average age was 48.8 +/- 12.3 years (range, 26-78 years). Manic/hypomanic switch was most frequently observed between 2 and 3 weeks after the antidepressant was increased to the ongoing dose. Antidepressants were decreased in 13 patients and discontinued in 23. Manic/hypomanic episodes lasted from 1 to 8 weeks. The patients in the switch group included a greater proportion of male subjects and had a higher frequency of family history of bipolar disorders than those in the nonswitch group. The mean doses of antidepressants were not significantly different between these groups. The higher frequency of manic/hypomanic switch occurring around the period when antidepressants begin to show clinical effects and the higher frequency of family history of bipolar disorders might suggest a biological susceptibility to antidepressants in patients of the switch group.

Subthreshold Hypomanic Symptoms in Progression From Unipolar Major Depression to Bipolar Disorder

“…In prospective studies, all who developed antidepressant-associated mania went on to later have episodes of spontaneous mania though these studies included a limited number of cases with pharmacologically-induced hypomania (10, 14). The family histories of those with antidepressant-associated mania further resemble those of individuals with spontaneous mania For these reasons, opinion leaders do not currently distinguish antidepressant-induced manias from those that arise spontaneously (38) and this assumption underlies our analyses (39, 40). The proposed revisions for DSM-V now also include the caveat “A full manic or hypomanic episode emerging during antidepressant treatment (medication, ECT etc) and persisting beyond the physiological effect of that treatment is sufficient evidence for a manic or a hypomanic episode diagnosis.”…”

Antidepressant-Emergent Mood Switch in Korean Adolescents With Mood Disorder

“…Faedda and colleagues 32 reported that AEMS was more frequent in girls, but Wada and colleagues 30 reported that the proportion of men was significantly higher in the AEMS group than in the non-AEMS group. Faedda and colleagues 32 reported that AEMS was more frequent in girls, but Wada and colleagues 30 reported that the proportion of men was significantly higher in the AEMS group than in the non-AEMS group.…”

“…AEMS was observed in 7% to 17% of youths with depression 8,29,30 and 50% to 58% of youths with BD. AEMS was observed in 7% to 17% of youths with depression 8,29,30 and 50% to 58% of youths with BD.…”

“…Several studies reported that multiple antidepressant exposure was more often observed with AEMS in adult BD. 30,39,41 Wada and colleagues 30 reported that 80.5% of AEMS occurred within the first 3 weeks of medication, and Goldberg and Whiteside 41 reported that most AEMS occurred within 4 to 8 weeks after the start of medication. The latency to AEMS was about 26 days, and 5 subjects (41.7%) experienced AEMS more than 30 days after starting antidepressants or lamotrigine.…”

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

“…9 Manic or hypomanic switches were most frequently observed between 2 and 3 weeks after the antidepressant dose was increased. 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.…”