Advertisement  

January 6, 2016
Can SSRI Use Cause Mania and Bipolar Disorder
in Depressed Patients?

London—Some antidepressants, especially serotonin reuptake inhibitors (SSRIs) and venlafaxine, increase the risk of mania and bipolar disorder in users, according to a new British study.

The report published in the online journal BMJ Open notes that previous treatment with specific antidepressants overall heightened the yearly risk 1.3% to 1.9%, (13.1-19.1 per 1,000 patient years). The use of SSRIs and venlafaxine, however, was linked to a 34% to 35% increased risk of being diagnosed with bipolar disorder and/or mania, according to the study team lead by King’s College London researchers.

For the study, researchers reviewed anonymized medical records of more than 21,000 adults receiving treatment for major depression between 2006 and 2013 at a large provider of inpatient and community mental healthcare in London. They then looked at subsequent diagnoses of bipolar disorder or mania following an original diagnosis of unipolar depression.

The overall yearly risk of a new diagnosis of mania and bipolar disorder between 2006 and 2013 was found to be 1.1%, with the peak age for diagnosis in patients 26 to 35, for whom the yearly risk was 1.2%.

In the cases reviewed, the most commonly prescribed antidepressants were SSRIs (35.5%); mirtazapine (9.4%); venlafaxine (5.6%); and tricyclics (4.7%).

“However, regardless of underlying diagnosis or etiology the association of antidepressant therapy with mania demonstrated in the present and previous studies highlights the importance of considering whether an individual who presents with depression could be at high risk of future episodes of mania,” study authors write.

With pertinent risk factors including a family history of bipolar disorder, a depressive episode with psychotic symptoms, young age at first diagnosis of depression, and depression that is unresponsive to treatment, “Our findings also highlight an ongoing need to develop better ways to predict future risk of mania in people with no prior history of bipolar disorder who present with an episode of depression,” they add.

Because the research was observational, the study team cautions that no absolute determinations can be made about cause and effect. In fact, latent bipolar disorder could be the explanation in some of the cases, they point out.

In an accompanying videocast, the researchers emphasize that the absolute risk of developing bipolar disorder is low and antidepressants are generally safe and effective treatments for depression and anxiety. They advise pharmacists and other healthcare professionals to caution patients against stopping treatment suddenly because of the risk of withdrawal symptoms.


Connect With U.S. Pharmacist
USP Google AppUSP Itunes App