Can antidepressants cause mania?

Can antidepressants cause manic episodes?

Antidepressants can dysregulate your mood leading to both hypomanic and manic episodes, a phenomenon known as antidepressant associated hypomania (AAH). ^[1] 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. ^[2]

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. ^[1]

Although AAH is most associated with bipolar depression, it has also been seen in unipolar depression and anxiety disorders. ^[1]

Women, younger people, and those with a family history of bipolar disease are most susceptible to AAH. ^[1] 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. ^[3]

What are mania and hypomania?

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:

• High energy: People in a manic state often feel highly energetic, restless, and have a reduced need for sleep.
• Better mood: They might feel an intense and persistent sense of happiness, excitement, or elation.
• Rapid thoughts and speech - Mania can lead to racing thoughts and fast-paced speech, making it difficult to focus.
• Increased goal-directed activity: Individuals may engage in impulsive or risky behaviors, such as overspending, reckless driving, or engaging in sexual promiscuity.
• Decreased need for sleep: Some people in a manic state may require very little sleep without feeling fatigued.
• Grandiosity: A sense of inflated self-esteem and belief in one's extraordinary abilities or talents might be present.
• Irritability: Mania can also manifest as irritability or agitation, leading to conflicts with others.
• Lack of insight: People in a manic state often have a reduced ability to recognize the consequences of their actions or the severity of their condition.

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.

Preventing antidepressant-associated mania

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.

• Thorough assessment: A comprehensive assessment of the patient's psychiatric history is crucial before prescribing antidepressants. This includes evaluating for any prior manic or hypomanic episodes.
• Family history: Ascertaining whether a patient has a family history of bipolar disorder can be helpful in recommending whether they embark on a course of antidepressants.
• Regular monitoring: Close monitoring of the patient's mood, behavior, and symptoms during antidepressant treatment can help detect any early signs of mania. Regular follow-up appointments allow for timely intervention if necessary.
• Combination therapy: In some cases, a combination of mood stabilizers and antidepressants might be considered to manage depressive symptoms while minimizing the risk of inducing mania.
• Patient education: Patients should be informed about the potential risks and benefits of antidepressant treatment, allowing them to make informed decisions and actively participate in their treatment plan.

Do antidepressants cause bipolar?

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. ^[4]

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. ^[4]

Secondly, antidepressants may exacerbate the course of the illness, prolonging symptoms in patients with bipolar for months or, even, years. ^[4]

That said, antidepressants are prescribed to up to 50% of patients with bipolar depression, despite the potential risk of inducing mania. ^[5] 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.

Which antidepressants are most likely to cause mania?

Research indicates that tricyclics, an older class of antidepressants, are more likely to cause manic episodes than other antidepressants. ^[4]

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. ^[5]

Tricyclic antidepressants include but are not limited to doxepin, amitriptyline, clomipramine, and imipramine.

Final thoughts

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.