title: Antidepressant-associated mania: a controlled comparison with spontaneous mania.
abstract: 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.
authors.affiliation: Bipolar and Psychotic Disorders Program, Mailman Research Center, McLean Hospital, Belmont, Mass.
authors.forename: A L
authors.initials: AL
authors.lastname: Stoll
authors.forename: P V
authors.initials: PV
authors.lastname: Mayer
authors.forename: M
authors.initials: M
authors.lastname: Kolbrener
authors.forename: E
authors.initials: E
authors.lastname: Goldstein
authors.forename: B
authors.initials: B
authors.lastname: Suplit
authors.forename: J
authors.initials: J
authors.lastname: Lucier
authors.forename: B M
authors.initials: BM
authors.lastname: Cohen
authors.forename: M
authors.initials: M
authors.lastname: Tohen
mesh_terms: 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
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D008996:Monoamine Oxidase Inhibitors; D005473:Fluoxetine; D016642:Bupropion