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Studies on AD-induced mania/switching

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This new one is interesting in that it found that mood cycling can be triggered by an antidepressant even YEARS after being on it.  Yikes.  Agitated dysphoria?  Been there, done that.  While on antidepressants, before BP was diagnosed.  Didn't realize the connection until much later (when it happened again recently, ugh). 

Agitated dysphoria after late-onset loss of response to antidepressants: a case report.

Phelps JR.

Samaritan Professional Bldg., 3517 Samaritan Drive, Corvallis, OR 97330, USA. jp@co-psych.com

BACKGROUND: Antidepressants can sometimes cause agitation, particularly in patients with bipolar disorder, but concern about such effects is generally limited to the first weeks and months of treatment.

METHOD: Demonstration of the occurrence of agitated dysphoria after loss of response to an antidepressant following continuous administration through 7 years of euthymia; with a worsening on dose increase; and recurrence of agitation on re-exposure 1 year later; in a patient whose previous dysthymia and recurrent depressions had no recognizable manic or hypomanic features.

RESULTS: Only when the antidepressant was removed, twice, was treatment an atypical antipsychotic and lithium effective.

CONCLUSION: An antidepressant which has been effective for as long as 7 years may still carry risk of inducing agitated dysphoria, even in apparently unipolar depression. In some patients, clinical vigilance for antidepressant-induced dysphoria may be warranted for extended periods of time.

J Affect Disord. 2005 Jun;86(2-3):277-80.

Pubmed link

This next one gives some general guidelines on who is most susceptible to AD-induced mania.  The rate of occurrence found here is lower than I would have expected.

Antidepressant-induced mania: an overview of current controversies.

Goldberg JF, Truman CJ.

Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY 11004, USA. jgoldber1@lij.edu

OBJECTIVE: The prevalence, characteristics, and possible risk factors associated with antidepressant-induced mania remain poorly described. The present review sought to identify published rates of antidepressant-induced mania and describe risk factors for its emergence.

METHODS: A MedLine search was conducted of journals that focused on mania or hypomania associated with recent antidepressant use. Data from published reports were augmented with relevant findings from recent clinical trials presented at scientific conferences.

RESULTS: Antidepressant-induced manias have been reported with all major antidepressant classes in a subgroup of about 20-40% of bipolar patients. Lithium may confer better protection against this outcome when compared with other standard mood stabilizers, although switch rates have been reported with comparable frequencies on or off mood stabilizers. Evidence across studies most consistently supports an elevated risk in patients with (i) previous antidepressant-induced manias, (ii) a bipolar family history, and (iii) exposure to multiple antidepressant trials.

CONCLUSION: About one-quarter to one-third of bipolar patients may be inherently susceptible to antidepressant-induced manias. Bipolar patients with a strong genetic loading for bipolar illness whose initial illness begins in adolescence or young adulthood may be especially at risk. Further efforts are needed to better identify high-vulnerability subgroups and differentiate illness-specific from medication-specific factors in mood destabilization.

Bipolar Disord. 2003 Dec;5(6):407-20.

Pubmed link
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