Am J Psychiatry 1994; 151:1642-1645
Copyright © 1994 by American Psychiatric Association
Antidepressant-associated mania: a controlled comparison with spontaneous mania
AL Stoll, PV Mayer, M Kolbrener, E Goldstein, B Suplit, J Lucier, BM Cohen and M Tohen
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.
