|
Manic
behaviors associated with fluoxetine in three 12- to 18-year-olds with
obsessive-compulsive disorder.
Go FS, Malley EE, Birmaher B, Rosenberg DR.
Department of Psychiatry at the University of Pittsburgh Medical Center, Pennsylvania,
USA.
In a sample of 40 youths (ages 11-17) with obsessive-compulsive disorder (OCD)
and mood disorders who were treated with behavior therapy, 20 patients received
serotonin reuptake inhibitors (SRIs) and 20 did not. In open-label clinical treatment,
30% of the patients (6/20) treated with SRIs developed manic or hypomanic
symptoms (5/15 on fluoxetine, 1/1 on sertraline). Symptoms included
impulsivity, grandiosity, pressured speech, and disinhibition and did not
resemble akathisia or "behavioral activation." These behaviors
emerged despite gradual dose elevation (2-5 mg/wk), conservative dosing
(maximum 40 mg daily), and careful weekly outpatient monitoring of each
patient. Fluoxetine-induced mania occurred at doses as low as 10 mg daily. It
is unclear whether mania/hypomania would appear in OCD children without
comorbid mood disorders or, alternatively, whether OCD is a stronger risk
factor than mood disorder for manic switch in SRI-treated youths. Clinicians
are advised to be aware of the risk and to be vigilant in monitoring manic and
hypomanic behaviors when using SRIs to treat OCD in youth, even with low doses
and gradual dose elevation.
|
