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Review
. 2010 Jun;121(6):404-14.
doi: 10.1111/j.1600-0447.2009.01514.x. Epub 2009 Dec 2.

Mania associated with antidepressant treatment: comprehensive meta-analytic review

L Tondo  1 , G Vázquez, R J Baldessarini
Affiliations
Review

Mania associated with antidepressant treatment: comprehensive meta-analytic review

L Tondo et al. Acta Psychiatr Scand. 2010 Jun.

Abstract

Objective: To review available data pertaining to risk of mania-hypomania among bipolar (BPD) and major depressive disorder (MDD) patients with vs. without exposure to antidepressant drugs (ADs) and consider effects of mood stabilizers.

Method: Computerized searching yielded 73 reports (109 trials, 114 521 adult patients); 35 were suitable for random effects meta-analysis, and multivariate-regression modeling included all available trials to test for effects of trial design, AD type, and mood-stabilizer use.

Results: The overall risk of mania with/without ADs averaged 12.5%/7.5%. The AD-associated mania was more frequent in BPD than MDD patients, but increased more in MDD cases. Tricyclic antidepressants were riskier than serotonin-reuptake inhibitors (SRIs); data for other types of ADs were inconclusive. Mood stabilizers had minor effects probably confounded by their preferential use in mania-prone patients.

Conclusion: Use of ADs in adults with BPD or MDD was highly prevalent and moderately increased the risk of mania overall, with little protection by mood stabilizers.

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