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Am J Psychiatry 1987; 144:1403-1411
Copyright © 1987 by American Psychiatric Association
Can antidepressants cause mania and worsen the course of affective illness?
TA Wehr and FK Goodwin
Intramural Research Program, NIMH, Bethesda, MD 20892.
Several investigators have recently challenged the belief that
antidepressants can precipitate mania or rapid cycling between mania and
depression. With one exception, there appear to be no placebo- controlled
studies of switches into mania in bipolar patients during antidepressant
treatment. Patients most likely to switch into mania during antidepressant
therapy have probably been excluded from maintenance treatment studies and
are probably overrepresented in studies at special research facilities. On
balance, the available evidence suggests that some bipolar patients become
manic, and a few experience rapid cycling, when they are treated with
antidepressants. The prevention of these responses will require further
research on risk factors and on the antimanic efficacy of coadministered
lithium or other mood stabilizers.
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