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Antidepressant withdrawal mania: Two case reports

Published online by Cambridge University Press:  23 March 2020

D. Pereira ,
I. Carreira Figueiredo ,
M. Marinho ,
R. Fernandes  and
V. Viveiros
I. Carreira Figueiredo
Affiliation:
Centro Hospitalar Psiquiátrico de Lisboa, Psychiatry, Lisboa, Portugal
M. Marinho
Affiliation:
Centro Hospitalar Psiquiátrico de Lisboa, Psychiatry, Lisboa, Portugal
R. Fernandes
Affiliation:
Centro Hospitalar Psiquiátrico de Lisboa, Psychiatry, Lisboa, Portugal
V. Viveiros
Affiliation:
Centro Hospitalar Psiquiátrico de Lisboa, Psychiatry, Lisboa, Portugal

Abstract

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Introduction

Although rarely reported, antidepressant discontinuation may induce hypomania or mania even in the absence of bipolar disorder [1,2].

Objectives

We report two cases of antidepressant withdrawal induced mania.

Methods

Clinical process consultation and PubMed search were performed in November 2016 using the search keywords antidepressant, mania and discontinuation.

Results

Case report 1: a dysthymic 60 years old woman with 20 years of psychiatric following had been treated with venlafaxine 150 mg/daily the past year. She abruptly stopped taking this drug, developing heightened mood, irritability and racing thoughts five days later. She was admitted at our hospital, initiating then valproate and antipsychotics. Two weeks later, the hypomania clinical state remitted completely.

Case report 2: a 64 years old woman, with a 12-year-old diagnosis of unipolar depression was brought to our emergency service with complaints of disorganized behavior, paranoid delusional ideas, excessive speech, irritable mood and reduced need for sleep, 1 week after abrupt trazodone 150 mg/daily discontinuation. Valproic acid 1000 mg/daily and olanzapine 20 mg/daily were introduced, with gradual improvement of symptoms. Two weeks later she was completely asymptomatic.

Conclusion

Psychiatrists should be aware of the risk of antidepressant withdrawal induced mania. More studies should be conducted about this subject, aiming for the clarification of risk factors and the establishment of clinical criteria for this phenomenon.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
e-Poster viewing: Cultural psychiatry
Information
European Psychiatry , Volume 41 , Issue S1: Abstract of the 25th European Congress of Psychiatry , April 2017 , pp. S540
Copyright
Copyright © European Psychiatric Association 2017

References

Andrade, CAntidepressant-withdrawal mania: a critical review and synthesis of the literature. J Clin Psychiatry 2004;65:987–993.10.4088/JCP.v65n0716CrossRefGoogle ScholarPubMed
Berardis, DEmerging mania following escitalopram withdrawal in a patient with unipolar depression managed with its reintroduction. J Psychiatr Pract 2014;20(3).Google Scholar
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