Can Antidepressants Spark a Manic or Hypomanic Episode?

Antidepressants Spark Mania
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I was first introduced to bipolar disorder about twelve years ago with the diagnosis of a family member. I witnessed a complete psychotic break up close and personal. The course of the episode went from insomnia and grandiosity to chasing hallucinated white mice with a broom, dodging non-existent cars on sidewalks, and screaming in terror while trying to jump out of a moving vehicle. As you can imagine, it was a horrifying experience for the entire family.

During the nearly two week hospitalization that followed, we learned that the episode was undoubtedly precipitated by St. Johns Wort, which is an herbal supplement sometimes recommended for mild depression (see St. John's Wort and BP - Unsafe). The psychiatrist at the time told us that unopposed antidepressants - antidepressants prescribed without a mood stabilizers such as Lithium or Depakote - are not recommended for those with bipolar disorder because of the possibility of sparking a manic episode. Since then I've noted that this is often shared between patients and consumers, but many practitioners feel there isn't enough empirical research to support this relationship.

However, a research team led by Mark A. Frye, M.D, with the Mayo Clinic reports significant evidence from a study comprised of 176 adults with bipolar disorder to warrant caution in the prescription of antidepressants.

Their findings are published in the American Journal of Psychiatry, Correlates of Treatment-Emergent Mania Associated with Antidepressant Treatment in Bipolar Depression. In this study, they found that 46 of the patients developed treatment-emergent mania or hypomania. The specific symptoms that predicted the emergence of mania were increased motor activity, speech, and language-thought disorder.

The research team concluded that if an individual has even minimal manic symptoms showing up in an otherwise full depressive episode, the individual is very likely to develop mania during treatment with antidepressants. "A careful examination of motor activation, pressured speech, and racing thoughts is warranted before starting antidepressant treatment in bipolar depression."

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