Mania associated with antidepressant treatment: Comprehensive meta-analytic review

Department of Psychiatry and Neuroscience Program, Harvard Medical School and McLean Division of Massachusetts General Hospital, Boston, MA, USA.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 12/2009; 121(6):404-14. DOI: 10.1111/j.1600-0447.2009.01514.x
Source: PubMed


To review available data pertaining to risk of mania-hypomania among bipolar (BPD) and major depressive disorder (MDD) patients with vs. without exposure to antidepressant drugs (ADs) and consider effects of mood stabilizers.
Computerized searching yielded 73 reports (109 trials, 114 521 adult patients); 35 were suitable for random effects meta-analysis, and multivariate-regression modeling included all available trials to test for effects of trial design, AD type, and mood-stabilizer use.
The overall risk of mania with/without ADs averaged 12.5%/7.5%. The AD-associated mania was more frequent in BPD than MDD patients, but increased more in MDD cases. Tricyclic antidepressants were riskier than serotonin-reuptake inhibitors (SRIs); data for other types of ADs were inconclusive. Mood stabilizers had minor effects probably confounded by their preferential use in mania-prone patients.
Use of ADs in adults with BPD or MDD was highly prevalent and moderately increased the risk of mania overall, with little protection by mood stabilizers.

Download full-text


Available from: Gustavo Vazquez
  • Source
    • "without; χ 2 ¼5.29, p ¼0.02), consistent with confounding by indication (Tondo et al., 2010). Among BD patients, switching risk was somewhat, but nonsignificantly, greater if an antidepressant was used (31.4% vs. 21.3%; "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: There is suggestive evidence that prior illness history may have little association with response to long-term treatment in bipolar disorder (BD) or recurrent major depressive disorder (MDD), but relationships of illness-history to treatment-response in acute episodes of depression require further testing. Methods: We tested for associations of selected measures of illness history with remission during treatment of an acute index episode of major depression in 515 mood-disorder patients (327 MDD, 188 BD), using bivariate and multivariate methods. Results: Remission of depression was more likely with lesser initial symptom-severity and bipolar diagnosis, but not related to years since illness-onset, previous depressions or episodes (based on counts, yearly rates, or %-of months ill), or other indices of illness-severity (hospitalization, co-morbidity, suicide attempt). Conclusions: Likelihood of response to standard treatments for acute major depressive episodes in MDD or BD appeared to be largely independent of prior illness-history.
    Full-text · Article · Nov 2015 · Journal of Affective Disorders
  • Source
    • "Many clinicians rely on plausibly expected, protective effects of ongoing mood-stabilizing treatments to limit risks of mood-switching when an antidepressant is given to a BD patient. However, evidence concerning putative protective effects of mood-stabilizers against mania or hypomania during treatment with antidepressants remains inconclusive and the point requires further, randomized-controlled trials (Licht et al., 2008 ; Tondo et al., 2010). Additional treatments for bipolar depression are being considered, but most remain experimental (Table 3). "

    Full-text · Article · Mar 2015
  • Source
    • "In summary, we believe that this patient had an antidepressant-induced mania due to excessively prolonged use of a substance with antidepressant properties and his bipolar disorder. There are studies that suggest a 4.58% (Tondo et al. 2010) to 15% (Pickar 1982) risk of switch to mania in bipolar patients treated with MAO inhibitors. According to DSM 5, 'a manic episode that emerges during antidepressant treatment but persists beyond the physiological effect of treatment is sufficient evidence of manic episode and therefore a bipolar disorder type I' (American Psychiatric Association 2013); given that for high doses of β-carbolines the half-life is 1 to 5 h (Riba et al. 2003), we believe this is the case of the patient presented. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is an increasing use of ayahuasca for recreational purposes. Furthermore, there is a growing evidence for the antidepressant properties of its components. However, there are no reports on the effects of this substance in the psychiatric setting. Harmaline, one of the main components of ayahuasca, is a selective and reversible MAO-A inhibitor and a serotonin reuptake inhibitor. We present the case of a man with bipolar disorder who had a manic episode after an ayahuasca consumption ritual. This patient had had at least one hypomanic episode in the past and is currently depressed. We discuss the diagnostic repercussion of this manic episode. There is lack of specificity in the diagnosis of substance-induced mental disorder. The knowledge of the pharmacodynamic properties of ayahuasca consumption allows a more physiopathological approach to the diagnosis of the patient.
    Full-text · Article · Feb 2015
Show more