Predicting Treatment-Emergent Mania to Tailor Pharmacotherapy in Bipolar Disorder

woman with emotional problems, blurry
woman with emotional problems, blurry
Researchers characterized the psychopathological features in patients with type II bipolar disorder who experienced treatment-emergent mania after exposure to antidepressants.

The findings of a post hoc analysis published in the Journal of Affective Disorders characterized the psychopathological features found in patients with type II bipolar disorder who experienced treatment-emergent mania after exposure to antidepressants.

The authors of the analysis identified 91 outpatients with type II bipolar disorder and categorized them as either having treatment-emergent mania (n=35) or not having treatment-emergent mania (n=56). Treatment-emergent mania was defined according to the criteria specified by the International Society of Bipolar Disorders and required at least 2 symptoms of mania, a Young Mania Rating Scale total score ≥12, and 2 consecutive days of symptoms occurring less than 12 weeks after a change in antidepressant dosage.

The investigators identified several predictors of treatment-emergent mania through their analyses, including attention-deficit/hyperactivity disorder, rapid cycling, borderline personality disorder, a major depressive episode with mixed features, a history of psychiatric hospitalization, or a substance use disorder. Patients who experienced treatment-emergent mania were also significantly more likely to be rated markedly ill, severely ill, or very severely ill on the Clinical Global Impressions-Bipolar Scale, and had significantly higher scores on the Young Mania Rating Scale.

Commonly co-occurring features in patients with treatment-emergent mania included a high Young Mania Rating Scale score and hyperthymic temperament, as well as attention-deficit/hyperactivity disorder with a substance use disorder or rapid cycling, respectively.

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The analyses also pointed to lithium and second-generation antipsychotics as protective against treatment-emergent mania.

Because of the nature of post hoc analyses, the study lacked a systematic record of participants’ pharmacological histories and did not control for the dose or class of antidepressants taken. The authors expressed that larger, more robust longitudinal studies would be needed to determine more precise psychiatric interventions for patients with treatment-emergent mania.


Fornaro M, Anastasia A, Monaco F, et al. Clinical and psychopathological features associated with treatment-emergent mania in bipolar-II depressed outpatients exposed to antidepressants. J Affect Disord. 2018;234:131-138.