ANTIDEPRESSANT-INDUCED MANIA AND CYCLE ACCELERATION - A CONTROVERSY REVISITED

Objective: The longitudinal course of 51 patients with treatment-refra ctory bipolar disorder was examined to assess possible effects of hete rocyclic antidepressants on occurrence of manic episodes and cycle acc eleration. Method: Using criteria established from life charts, invest igators rated the patients' episodes of mania or cycle acceleration as likely or unlikely to have been induced by antidepressant therapy. Di scriminant functions analyses were performed to assess predictors of v ulnerability to antidepressant-induced mania or cycle acceleration. Fu rther, the likelihood of future antidepressant-induced episodes in per sons who had had one such episode was assessed. Results: Thirty-five p ercent of the patients had a manic episode rated as likely to have bee n 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 assess ed. Younger age at first treatment was a predictor of vulnerability to antidepressant-induced cycle acceleration. Forty-six percent of patie nts 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-indu ced and not attributable to the expected course of illness in one-thir d of treatment-refractory bipolar patients, and rapid cycling is induc ed in one-fourth. Antidepressant-induced mania may be a marker for inc reased vulnerability to antidepressant-induced cycle acceleration. Ant idepressant-induced cycle acceleration (but not antidepressant-induced mania) is associated with younger age at first treatment and may be m ore likely to occur in women and in bipolar II patients.