ANTIDEPRESSANT-ASSOCIATED MANIA - A CONTROLLED COMPARISON WITH SPONTANEOUS MANIA

Objective: Antidepressants have been associated with the induction of mania and rapid cycling. This study examined whether antidepressant-as sociated manic states differ in any way from spontaneous mania. Method : Forty-nine consecutive inpatients with antidepressant-associated man ic states were compared with 49 matched inpatients with spontaneous ma nia in a blind, retrospective chart review. Results: Across virtually every clinical measure examined, the patients with antidepressant-asso ciated manic states experienced milder and more time-limited manic epi sodes than the patients with spontaneous mania. The patients with anti depressant-associated manic states were subject to frequent checking b y nurses and hall restriction for a significantly shorter period of ti me than the patients with spontaneous mania. The patients with antidep ressant-associated manic states also had significantly less severe lev els of delusions, hallucinations, psychomotor agitation, and bizarre b ehavior, according to a standard rating instrument, than the patients with spontaneous mania. For further study the patients with antidepres sant-associated mania were divided into subgroups taking four individu al classes of antidepressant drugs: tricyclics (N=19), fluoxetine (N=1 3), monoamine oxidase inhibitors (MAOIs) (N=8), and bupropion (N=6); t hree patients taking combinations of drugs were not included in these analyses. The patients with MAOI- and bupropion-associated mania had a slightly lower overall rating of severity of psychopathology at admis sion than the subgroups with fluoxetine- and tricyclic-associated mani a. Conclusions: Antidepressant-associated mania appears to be a milder and more time-limited syndrome than spontaneous mania and may represe nt a distinct clinical entity. MAOIs and bupropion may be associated w ith milder manic states than either tricyclic drugs or fluoxetine.