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Comment in:
·
Am
J Psychiatry. 1996 Sep;153(9):1239.
Antidepressant-induced mania and cycle acceleration: a
controversy revisited.
Altshuler LL, Post RM, Leverich GS,
Mikalauskas K, Rosoff A, Ackerman L.
Brentwood VA Medical Center, Los
Angeles, USA.
OBJECTIVE: The longitudinal course of 51 patients with
treatment-refractory bipolar disorder was examined to assess possible effects of
heterocyclic antidepressants on occurrence of manic episodes and cycle
acceleration. METHOD: Using criteria established from life charts, investigators
rated the patients' episodes of mania or cycle acceleration as likely or
unlikely to have been induced by antidepressant therapy. Discriminant function
analyses were performed to assess predictors of vulnerability to
antidepressant-induced mania or cycle acceleration. Further, the likelihood of
future antidepressant-induced episodes in persons who had had one such episode
was assessed. RESULTS: Thirty-five percent of the patients had a manic episode
rated as likely to have been antidepressant-induced. No variable was a predictor
of vulnerability to antidepressant-induced mania. Cycle acceleration was likely
to be associated with antidepressant treatment in 26% of the patients assessed.
Younger age at first treatment was a predictor of vulnerability to
antidepressant-induced cycle acceleration. Forty-six percent of patients with
antidepressant-induced mania, but only 14% of those without, also showed
antidepressant-induced cycle acceleration at some point in their illness.
CONCLUSIONS: Mania is likely to be antidepressant-induced and not attributable
to the expected course of illness in one-third of treatment-refractory bipolar
patients, and rapid cycling is induced in one-fourth. Antidepressant-induced
mania may be a marker for increased vulnerability to antidepressant-induced
cycle acceleration. Antidepressant-induced cycle acceleration (but not
antidepressant-induced mania) is associated with younger age at first treatment
and may be more likely to occur in women and in bipolar II
patients.
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