Research report Clinical variables related to antidepressant-induced mania in bipolar disorder

Background: The development of mania or hypomania during antidepressant treatment is a serious complication of the clinical management of bipolar disorder (BP). The primary aim of this study was to evaluate the clinical variables related to antidepressantinduced mania or hypomania (AIM) in patients with BP. Methods: DSM-IV BP-I or BP-II patients who had had at least one depressive episode treated with antidepressants were considered. Patients were subdivided into two groups according to the presence (n=30) or absence (n=106) of manic or hypomanic episodes occurring during antidepressant treatment. Possible predictive clinical variables of AIM were considered: gender, diagnostic subtype, age at onset, duration of illness, duration of untreated illness, type of antidepressant administered, number of previous spontaneous hypomanic or manic episodes, number of previous depressive episodes, presence of lifetime suicide attempts, presence of mood stabilizer treatments, presence of psychotic symptoms during spontaneous episodes, family history for psychiatric disorders in first degree relatives. Data were compared between the two groups, with (AIM+) and without (AIM�) antidepressant-induced mania, using Student's t tests and chi-square tests. Results: The lack of mood stabilizer treatments during antidepressant therapy (chi-square=37.602,df=1,pb0.001) and the exposure to tricyclic antidepressants (chi-square=4.901, df=1,pb0.05) resulted significantly associated to the development of AIM. Limitations: This study was not done under controlled conditions and the relatively small sample studied warrants further replications. Conclusions: These results point out the risk of mania induction associated to the use of tricyclic antidepressants in BP patients, mainly in absence of adequate mood stabilizers.