Sep 29th 2023
Feeling unreasonably invigorated, chockful of energy, and invincible are not symptoms usually experienced by people prescribed antidepressants. However, it may be a result of your antidepressants triggering a manic or hypomanic episode.
Antidepressants can dysregulate your mood leading to both hypomanic and manic episodes, a phenomenon known as antidepressant associated hypomania (AAH).  There is ambiguity about whether antidepressants are the outright cause of mania or hypomania in patients with major depressive disorder, or whether they trigger undiagnosed bipolar disorder. 
While not all individuals with bipolar disorder will experience mania in response to antidepressants, there is evidence suggesting a connection between certain types of antidepressants and the onset of manic symptoms. 
Although AAH is most associated with bipolar depression, it has also been seen in unipolar depression and anxiety disorders. 
Women, younger people, and those with a family history of bipolar disease are most susceptible to AAH.  It is possible that younger people appear more likely to experience AAH as the peak age for contracting bipolar disorder is between 15 and 19 years of age. 
Mania is an elevated mood state characterized by intense euphoria, high energy levels, and a heightened sense of self-confidence. It is most exhibited by people with bipolar disorder. During a manic episode, individuals may experience:
Hypomania is a less severe form of mania, characterized by similar symptoms but to a milder degree. While the symptoms of hypomania are noticeable, they don't usually lead to severe disruptions in daily functioning or require hospitalization.
To mitigate the potential risks associated with antidepressants and mania, doctors and patients must foster an open, honest channel of communication. The following steps could help minimize the risk of inducing mania during antidepressant treatment.
There is no evidence suggesting that antidepressants cause bipolar disease in patients. However, the administering of antidepressants to people with bipolar can give two causes for concern. 
Firstly, antidepressants may precipitate manic or hypomanic episodes in patients with bipolar disease. They may also trigger a manic episode in a patient with major depressive disorder who hasn’t yet received a bipolar diagnosis. 
Secondly, antidepressants may exacerbate the course of the illness, prolonging symptoms in patients with bipolar for months or, even, years. 
That said, antidepressants are prescribed to up to 50% of patients with bipolar depression, despite the potential risk of inducing mania.  If you have bipolar disorder or depression, it is essential to weigh up the risks and benefits of starting a course of antidepressants with your healthcare provider.
Research indicates that tricyclics, an older class of antidepressants, are more likely to cause manic episodes than other antidepressants. 
A 2004 study found that tricyclic antidepressants triggered manic episodes in 10% of participants, compared with a rate of 3.2% for all other antidepressants combined. 
Tricyclic antidepressants include but are not limited to doxepin, amitriptyline, clomipramine, and imipramine.
It is important to note that the risk of inducing manic or hypomanic episodes varies among individuals and is influenced by factors such as genetic predisposition, family history of bipolar disorder, and overall mental health status.
If you have been diagnosed with major depressive disorder and are taking antidepressants, experiencing bouts of mania is irregular. You may have undiagnosed bipolar disorder, or these manic episodes may be medication induced.
If you have bipolar disorder, you may experience antidepressant induced mania, or AAH, at any time during your antidepressant course.
It is essential to work closely with your doctor during your course of antidepressants. Be honest and open about your symptoms and they may be able to provide an alternate medical solution, such as mood stabilizers.
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