Risk Factors for Antidepressant-Induced Mania in Bipolar Disorder

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Patients with a history of affective psychosis and a greater number of manic episodes were less likely to be prescribed an antidepressant.
Patients with a history of affective psychosis and a greater number of manic episodes were less likely to be prescribed an antidepressant.

Patients with bipolar disorder are more likely to be exposed to antidepressants if they are female, older, have a lower number of manic episodes, no history of affective psychosis, and a greater chronicity of illness. Furthermore, women with bipolar disorder are more likely to develop antidepressant-induced mania. A study reporting these findings was recently published in The Journal of Clinical Psychiatry.

The data analyzed for this study were taken from a larger naturalistic, longitudinal, observational study of American adults with bipolar disorder from February 2006 to December 2010. Participants were excluded for secondary psychiatric illnesses and/or gross intellectual impairment. The study sample included 309 individuals with bipolar disorder type I (74.3%), 66 with type II (15.9%), 27 with not otherwise specified bipolar disorder (6.5%), and 14 with bipolar type schizoaffective disorder (3.4%).

Multivariate logistical regression modeling showed that antidepressant exposure was strongly associated with greater illness chronicity (OR =2.29, P =.04), older age (OR =1.03, P =.04), female sex (OR =2.73, P =.005), and to a smaller extent, Caucasian race (OR =0.44, P =.051). The only factor associated with a history of antidepressant induced mania was female sex (OR =3.74, P =.02).

Study investigators conclude that although “these data cannot predict with precision which patients will or will not develop [antidepressant-induced mania] on an individual basis, our results support the consideration of sex in the design of studies targeted toward [antidepressant-induced mania], the development of clinical prediction tools for [antidepressant-induced mania], and for potential efforts to prevent this adverse outcome.”

Reference

Williams AJ, Lai Z, Knight S, Kamali M, Assari S, McInnis MG. Risk factors associated with antidepressant exposure and history of antidepressant-induced mania in bipolar disorder [published online May 15, 2018]. J Clin Psychiatry. doi: 10.4088/JCP.17m11765

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