Do antidepressants increase risk of mania and bipolar disorder in people with depression?

Patel R, Reiss P, Shetty H et al. BMJ Open 2015;5:e008341 doi:10.1136/bmjopen-2015-008341

Objectives
To investigate the association between antidepressant therapy and the later onset of mania/bipolar disorder.

Design
Retrospective cohort study using an anonymised electronic health record case register.

Setting
South London and Maudsley National Health Service Trust, a large provider of inpatient and community mental healthcare in the UK.

Participants
21 012 adults presenting to SLaM between 1 April 2006 and 31 March 2013 with unipolar depression.

Exposure
Prior antidepressant therapy recorded in electronic health records.

Main outcome measure
Time to subsequent diagnosis of mania or bipolar disorder from date of diagnosis of unipolar depression, censored at 31 March 2014.

Methods
Multivariable Cox regression analysis with age and gender as covariates.

Results
The overall incidence rate of mania/bipolar disorder was 10.9 per 1000 person-years. The peak incidence of mania/bipolar disorder incidence was seen in patients aged between 26 and 35 years. Prior antidepressant treatment was associated with an increased incidence of mania/bipolar disorder ranging from 13.1 to 19.1 per 1000 person-years. Multivariable analysis indicated a significant association with selective serotonin reuptake inhibitors and venlafaxine.

Conclusions
In people with unipolar depression, antidepressant treatment is associated with an increased risk of subsequent mania/bipolar disorder. These findings highlight the importance of considering risk factors for mania when treating people with depression.

[birdybird]

Tell you what. When they thought I was depressed with some anxiety, they handed me an SSRI. I went through the roof. I almost lost my job, couldn't go to sleep without crying myself there, and self harmed, the first time pm that ever left scsrs.
It was the worst manic in my life. It got better the second I cut the SSRI cold turkey, despite efforts to ween off the drug.
I was diagnosed later with bipolar.

[kalaupun]

"It's safe, except when it destroys people's lives, but whatev"

[valeriezushin]

BS! That’s like saying you were pre disposed to getting a broken nose before I pushed you down the steps! Stop blame the patient and stop prescribing this poison!!!

[CiaraJay]

My bipolar only came out when i was on antidepressants. Been off and haven’t been hypo since. I will never in my life take antidepressants again. It ruined my life. Lost a lot of friendship.

[carltonmusic]

This guy is getting paid from the pharmaceutical companies to release false information.

[dtribes]

Absolutely cannot tell what is being said here. From 00:35 to 00:50, Dr. Patel says the drugs are safe, but that people who take them can exhibit symptoms of mania "as part of a bipolar disorder."

That's contradictory and unclear.  


The next statement is that bipolar disorder (BD) often presents as depression first, which implies that the mania he mentioned "as part of a bipolar disorder" was a pre-existing condition waiting in the wings, not 100% created by antidepressants (ADs). He goes on to say that those who exhibit mania on ADS "already had a propensity." Presumably the people about whom there is some doubt on the natural vs iatrogenic cause question are those who had not been manic before, and hypthetically wouldn't have been in the relevant instance were it not for the AD. That sounds more like a vulnerability than a propensity. He advises that bipolar be considered when people present with depression. He closed with the statement that ADs carry of risk of inducing mania, the risk is small, and the drugs are safe.

They're not safe if they can bring on mania. That's one of the most perilous plights on earth.

The risk is low? How low, and what is known about the odds of mania in studies where half the depressed patients are assigned to interpersonal therapy and half to ADs? How about in head-to-head comparisons of drugs or classes of drugs? How likely is that mania is exhibited by age 23, 30, 40, and so on? How do mania rates compare in the never-medicated depressed, the medicated/post-medicated depressed, and the never-depressed?

Leaving aside the causality question, does mania during/after AD use respond to the same drugs as old-fashioned mania? How about the course if left untreated?

What were the outcomes for those among the 21, 000 patients who developed mania on the drugs? Are they in treatment for bipolar disorder to this day? What percent of those being treated for BD in the overall population were on an AD before the BD diagnosis, and so on? Seems like NHS has the data and Dr. Patel et al. have the means to analyze it.

The drug companies will be on the hook for billions if they've been concealing this--whatever it is.

[AlexaKissLive]

I have bipolar and was just put on depression medication to try and deal with my major ups and downs. I’m so glad to see some info on side effects this may have on me!! I haven’t watched it yet but already - THANKYOU

[m.bition]

3:28 yeah... says a guy who never faled a victim to ssri induced mania... no it's not low buddy, it happens a lot... ur just saying whatever is better for your reputation as a doctor and better for pharmaceutical industry

[Peanutdog]

My ex was diagnosed with bipolar disorder after he stopped taking his lexopro because it stopped working. Him stopping his medication made him have a manic episode it was terrifying I was with him when he drove his car into a tree. He threw me and my dog out first but yeah. After that he was in a mental health facility that he could not leave and was put on more medications seroqal was one of them. Later after we broke up I learned about Nick Drake. Everything came together then and i could see how this medication effects to users mental abilities. It's sad to think but I believe alot of the suicides associated with antidepressants were caused by an attempt to stop taking the medication. And suicide and manic episodes are withdrawal symptoms to antidepressants because the body is deficient in serotonin at that time.

[michaelcoughlin]

There is a direct causative relationship between taking antidepressants and developing mania. I did a 6.5 hour screening prior to taking Paxil. No bipolar diagnosis. I developer hypomania after just 2 days of Paxil. Barely slept for 3 weeks

[sethk]

Never had mania until age 33 on lexapro.

[bookbookism]

This is very concerning and upsetting. I experienced severe mania upon taking Sertraline and was given a bipolar dx even though I never experienced mania before taking the sertraline. I'm so confused- can someone explain how my bipolar dx is correct despite never experiencing mania outside the context of taking an antidepressant?!

[jeremiahtnepe]

I have Bi Polar 2, I first started Lamictal to stabilise my mood- which it did, but I was base lining with low level depression that at first I thought was normal and how everyone felt. I then went on Lexapro which helped bring me to a pretty good level. I honestly think it only worked for me because I was also taking a stabiliser. I’m not a doctor but would definitely recommend taking a mood stabiliser first to see where you level of at before an antidepressant just in case it throws you through the wall.

[Desdemiaus]

They put me on fluoxetine for my depression and anxiety but I also have OCD and bipolar 1 and I went into mania for the entire month I was on them

[mrfake]

Zoloft helped me connect the dots that I have bipolar. Pushed me into severe mania

[joeldecoster]

Damn antidepressants. destroyed my life

[wisemonk]

Golden line: people who develop bipolar mania after antidepressant already had high propensity to do so without antidepressants. It's just a trigger then! 🙏

[alice]

I had a manic episode because of Pristiq. I came off it and I’m not on any SSRI/SNRI - just agomelatine. I’m positive that since that incident (few years ago now) I catch myself getting hypomanic very often. I’m not diagnosed Bipolar (PTSD/anxiety/depression and ADHD have been or are diagnosed) but have had to see a psychiatrist since. I was told there are two kinds of psychiatrists - the ones who think if you have such a reaction, the bipolar was there and meds just allowed it to come out or the ones who can see that it was just medically induced and a reaction to the pills.

[SPsounds]

It took me 4 years to find out i had Manic on ssri's it was hell... But I switched doctor and zoloft to trintellix and much better

[KarolB]

I was giving antidepressants and it made me completely manic even though I'm not bipolar. Why?