Suggest Treatment For Antidepressant Induced Mania

Posted on Wed, 25 Jun 2014

Question: I have bipolar disorder and recently started taking the drug Fetzima. I have had problems in the past with antidepressants causing hypomania after only a short time of taking them. I feel that way right now- and have been experiencing pressured speech and racing thoughts, etc. i know I have to stop taking this medication- I am just a little afraid of the withdrawal symptoms, even though I've only been on the 40mg dose for a few days. Can you tell me if I'll be okay if I stop it now,after only a total of five days?

Answered by Dr. Manisha Gopal (1 hour later)

Brief Answer:
add a mood stabilizer to antidepressant

Detailed Answer:
Hello,
You have a propensity to develop antidepressant induced mania. In such cases ( and these are not uncommon in clinical parctice) it is best to start a mood stabilizer for treating depression & add an antidepressant over it.
Repeated induction of manic episodes are not good and may finally lead to development of bipolar disorder.
So, if you have developed racing thoughts, increased activity and decreased need of sleep within 5 days of starting fetzima- best will be to add sodium valporate/ lithium/ carbamazepine/ olanzapine. You should talk to your doctor regarding this.
Wish you good health!

Please ask more queries to clarify any doubts.
Dr. Manisha Gopal
MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Manisha Gopal (1 hour later)

Hello Dr XXXXXXX
Thank you for your answer. I do have bipolar disorder and I am on Seroquel and gabapentin, as well as clonazepam annd Trileptal. I have not been able to maintain a steady dosage of any antidepressant for quite some time due to the "switching" that can occur from these medications. I can tell almost immediately when I will not be able to handle a medication.. The last one was Viibryd, which lasted a couple of months.
I am thankful for this doctor service even though I am on Disability so don't have alot of money.I appreciate your help.Have a pleasant evening.

Answered by Dr. Manisha Gopal (3 hours later)

Brief Answer:
dose of seroquel in inadequate

Detailed Answer:
Hello,
The problem is not that antidepressants are your culprit, but its the dosage of mood stabilizer (most possibly seroquel in your case) which is not suffecient.

So, till your mood stabilizer is not in adequate level- you will always be prone to develop either mania or depression or get drug induced manic symptoms. The main role of mood stabilizer is to keep mood stable, i.e.- not let the mood slip in either mania or depressive symptoms.

Ideally, when we have a patient who is prone to develop mania due to antidepressants- either olanzapine or sodium valporate or oxcarbazepine are better choices.

Seroquel is good molecule, has lesser side effects compared to valporate but is less effective.
I cant apprecaite why you are taking gabapentine. If it is a mood stabilizer, stop it as it is not a choice.
Please talk to your doctor and ask him to increase the dose of seroquel- may be upto 400-600mg at least and see if there is any switch. You haven't mentioned he dosage in query or I would have helped in a better way.

Also get TSH levels done; low thyroid also makes a person prone to switch.

Hope the reply helps you.

Feel free to ask more questions for clarification.

Dr. Manisha Gopal
MD Psychiatry

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar