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Antidepressant therapy may increase risk for mania in adults with depression

In a retrospective cohort study, antidepressant treatment was associated with increased risk for subsequent mania/bipolar disorder among adults with unipolar depression.

“The occurrence of mania and hypomania in people receiving antidepressant therapy is an adverse effect of treatment with antidepressant medication. However, it is unclear whether antidepressants cause acute mania or hypomania in patients with unipolar depression or trigger the expression of an underlying bipolar disorder,” Rashmi Patel, PhD, of King’s College, London, and colleagues wrote.

Rashmi Patel

To assess the association between antidepressant therapy and later onset of mania/bipolar disorder, researchers analyzed data from the South London and Maudsley National Health Service Trust for 21,012 adults presenting with unipolar depression between April 2006 and March 2013.

Overall, the incidence rate for mania/bipolar disorder was 10.9 per 1,000 person-years.

Peak incidence of mania/bipolar disorder was 12.3 per 1,000 person-years among adults aged 26 to 35 years.

Prior antidepressant treatment was associated with an increased incidence of mania/bipolar disorder, ranging from 13.1 to 19.1 per 1,000 person-years.

There was a significant association between selective serotonin reuptake inhibitors (HR = 1.34; 95% CI, 1.18-1.52) and venlafaxine (HR = 1.35; 95% CI, 1.07-1.7) with mania/bipolar disorder onset.

“Although our findings do not demonstrate any causal link between antidepressant therapy and bipolar disorder, the association of antidepressant therapy with mania in people being treated for depression reinforces the importance of considering risk factors for mania or hypomania in people who present with an episode of depression,” the researchers wrote. “Our findings also highlight an ongoing need to develop better ways to predict future risk of mania in people with no prior history of bipolar disorder who present with an episode of depression.” – by Amanda Oldt

Disclosure: Patel reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.