How often does an SSRI precipitate mania?

[ryerica22]

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I'm just curious if you guys have ever seen it happen. In our psych evals, we always screen for it, but most of the time, there are other factors such as substance use which also effect the responses we get. But I have never seen anyone go into a full blown manic episode from an SSRI. Whenever, I find anyone who endorses the history of manic episodes, I also come to find that there is a lot of caffeine involved and there is a possibility of Borderline personality disorder as well. However, some providers I've seen put them on Latuda and Lithium for years. The patients then ask me how long do they need to continue the meds, if they have a manic episode in the past, I say indefinitely.

On a related note, I see the diagnosis of Bipolar Disorder being overly prescribed to adolescents.

 

[clausewitz2]

The numbers are all over the place unfortunately. Depending on what study you look at, it might be between 3 and 30% over ten weeks. Effexor and TCAs seem much more likely to precipitate florid mania. Have to be careful about the substance use and the chronology, since people who are manic often love them some drugs. Also want to make sure people are not mistaking akathisia for mania, since the former is most definitely a thing SSRIs can do.

 

[Dharma]

Homework

 

[NickNaylor]

The most common numbers I see are 10-20%, and this is in studies including patients with bona fide bipolar I treated with antidepressants.

 

[st2205]

I’ve seen it maybe once. But the new thinking is that it doesn’t, as BPD is episodic and of course sometimes there will be a temporal association of the onset of SSRI with mania. Anyway, bigger issue is that bipolar (legitimate) is so rare. But I’ve seen 3-4 cases of people with no mania history end up manic and then psychotic from Effexor.

 

[Crayola227]

what about patients getting hypomanic and not full blown mania?

 

[tr]

I have seen two cases of florid, first lifetime episode manias precipitated by SSRI monotherapy. Once Prozac and once Zoloft. One case required hospitalization. Both patients had mild cyclothymia prior to that but never actual mania.

I have seen milder hypomanic elevations a few times as well but those all went away when the SSRI was stopped.

 

[clozareal]

I always hear otherwise, but this task force reviewed this and report that monotherapy SSRI switch rate is no different than placebo. Would love to hear your guys' thoughts!

The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. - PubMed - NCBI