Agitated dysphoria after late-onset loss of response to antidepressants: a case report.
BACKGROUND
Antidepressants can sometimes cause agitation, particularly in patients with bipolar disorder, but concern about such effects is generally limited to the first weeks and months of treatment.


METHODS
Demonstration of the occurrence of agitated dysphoria after loss of response to an antidepressant following continuous administration through 7 years of euthymia; with a worsening on dose increase; and recurrence of agitation on re-exposure 1 year later; in a patient whose previous dysthymia and recurrent depressions had no recognizable manic or hypomanic features.


RESULTS
Only when the antidepressant was removed, twice, was treatment an atypical antipsychotic and lithium effective.


CONCLUSIONS
An antidepressant which has been effective for as long as 7 years may still carry risk of inducing agitated dysphoria, even in apparently unipolar depression. In some patients, clinical vigilance for antidepressant-induced dysphoria may be warranted for extended periods of time.
Phelps
James R
JR
Samaritan Professional Bldg., 3517 Samaritan Drive, Corvallis, OR 97330, USA. jp@co-psych.com
D017109:Akathisia, Drug-Induced / Q000209:etiology*; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000188:drug therapy* / Q000523:psychology; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008875:Middle Aged; D011613:Psychotherapy; D012008:Recurrence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use; D016896:Treatment Outcome
D000927:Anticonvulsants; D000928:Antidepressive Agents; D016651:Lithium Carbonate; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline