Antidepressant-associated mania:
a controlled comparison with spontaneous mania

Stoll AL, Mayer PV, Kolbrener M, Goldstein E,
Suplit B, Lucier J, Cohen BM, Tohen M
Bipolar and Psychotic Disorders Program,
Mailman Research Center,
McLean Hospital, Belmont, Mass.
Am J Psychiatry 1994 Nov; 151(11):1642-5


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.
Bipolar disorder
Bipolar depression
The manic spectrum
Bupropion and mania
Bipolar polypharmacy
Drug-induced depression
Antidepressant-induced mania
Bupropion for nicotine quitters
Bupropion vs dexamphetamine
Bupropion (Wellbutrin) vs SSRIs
Bupropion for depressed bipolars
Which antidepressants flick the switch?
Bupropion and the dopamine transporter
Antidepressant-induced mania - 'bipolar III'
Dopaminergic and noradrenergic antidepressants

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