Antidepressant-associated mania: a controlled comparison with spontaneous mania.
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.


METHODS
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.
Stoll
A L
AL
Bipolar and Psychotic Disorders Program, Mailman Research Center, McLean Hospital, Belmont, Mass.
Mayer
P V
PV
Kolbrener
M
M
Goldstein
E
E
Suplit
B
B
Lucier
J
J
Cohen
B M
BM
Tohen
M
M
D000328:Adult; D017109:Akathisia, Drug-Induced / Q000175:diagnosis / Q000209:etiology; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D016642:Bupropion / Q000009:adverse effects; D003702:Delusions / Q000139:chemically induced / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects; D006212:Hallucinations / Q000139:chemically induced / Q000175:diagnosis; D006760:Hospitalization; D006801:Humans; D008297:Male; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects; D011595:Psychomotor Agitation / Q000175:diagnosis; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D008996:Monoamine Oxidase Inhibitors; D005473:Fluoxetine; D016642:Bupropion