THE AMERICAN JOURNAL OF PSYCHIATRY Can Antidepressants Cause Mania and Worsen the Course of Affective Illness?

Several investigators have recently challenged the belief that antidepressants can precipitate mania or rapid cycling between mania and depression. With one exception, there appear to be no placebo-controlled studies of switches into mania in bipolar patients during antidepressant treatment. Patients most likely to switch into mania during antidepressant therapy have probably been excluded f rom maintenance treatment studies and are probably overrepresented in studies at special research facilities. On balance, the available evidence suggests that some bipolar patients become manic, and a few experience rapid cycling, when they are treated with antidepressants. The prevention of these responses will require further research on risk factors and on the antimanic efficacy of coadministered lithium or other mood stabilizers. (AmJ Psychiatry 1987; 144:1403-1411) The physician must be particularly careful not to go to extremes... he may overexcite the patient whose prevail-ing mood is melancholic... a ruthless excitation feeds the tendency to rage which is associated with the disease.-J.C. Heinroth (1818) T he treatment of affective disorders was revolution-ized in the late 1950s by the advent of antidepres-sant medications, and the efficacy of these drugs has been well documented in the years since their intro-duction. During the same period, however, reports have regularly appeared indicating that these drug