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Antidepressant-associated
mania: a controlled comparison with spontaneous mania.
Stoll AL, Mayer PV,
Kolbrener M, Goldstein E, Suplit B, Lucier J, Cohen BM, Tohen
M.
Bipolar and Psychotic Disorders Program, Mailman Research Center,
McLean Hospital, Belmont, Mass.
OBJECTIVE: Antidepressants have been
associated with the induction of mania and rapid cycling. This study examined
whether antidepressant-associated manic states differ in any way from
spontaneous mania. METHOD: Forty-nine consecutive inpatients with
antidepressant-associated manic states were compared with 49 matched inpatients
with spontaneous mania in a blind, retrospective chart review. RESULTS: Across
virtually every clinical measure examined, the patients with
antidepressant-associated manic states experienced milder and more time-limited
manic episodes than the patients with spontaneous mania. The patients with
antidepressant-associated manic states were subject to frequent checking by
nurses and hall restriction for a significantly shorter period of time than the
patients with spontaneous mania. The patients with antidepressant-associated
manic states also had significantly less severe levels of delusions,
hallucinations, psychomotor agitation, and bizarre behavior, according to a
standard rating instrument, than the patients with spontaneous mania. For
further study the patients with antidepressant-associated mania were divided
into subgroups taking four individual classes of antidepressant drugs:
tricyclics (N = 19), fluoxetine (N = 13), monoamine oxidase inhibitors (MAOIs)
(N = 8), and bupropion (N = 6); three patients taking combinations of drugs were
not included in these analyses. The patients with MAOI- and bupropion-associated
mania had a slightly lower overall rating of severity of psychopathology at
admission than the subgroups with fluoxetine- and tricyclic-associated mania.
CONCLUSIONS: Antidepressant-associated mania appears to be a milder and more
time-limited syndrome than spontaneous mania and may represent a distinct
clinical entity. MAOIs and bupropion may be associated with milder manic states
than either tricyclic drugs or fluoxetine.
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