Cromwell House Community Mental Health Centre, Manchester, UK.
J Psychopharmacol. 2011 Mar;25(3):306-13. doi: 10.1177/0269881109359094. Epub 2010 Feb 15.
We critically appraised all published reports of hypomania and mania following antidepressant termination. To increase reliability and validity we devised diagnostic criteria for an antidepressant discontinuation or withdrawal 'manic state' based primarily on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition substance withdrawal criteria. A systematic literature review identified 24 reports meeting our criteria. Mean age was 39 years (range 18-74), men and women were approximately equally represented, and more cases involved people with unipolar (n = 19) than bipolar disorder (n = 4). The median duration of preceding antidepressant treatment was 12 weeks (range 4 weeks-12 years). All major antidepressant classes were involved (tricyclic antidepressants = 13; selective serotonin reuptake inhibitors = 5; monoamine oxidase inhibitors = 3; selective serotonin-norepinephrine reuptake inhibitors = 2; miscellaneous = 1). More cases followed abrupt antidepressant withdrawal (n = 11) than a tapered withdrawal (n = 6). Six cases appeared to meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition for a manic episode, with two cases requiring inpatient admission. Of the 24 cases, nine resolved spontaneously without treatment (median duration = 25.5 days), six responded to antimanic drugs, four resolved following antidepressant reinstatement, and treatment was unclear in five cases. We conclude that antidepressant discontinuation hypomania/mania is a valid syndrome. It should be added to the differential diagnosis of hypomania/mania. The clinical implications and possible mechanisms are discussed.
我们批判性地评估了所有关于抗抑郁药停药后出现轻躁狂和躁狂的已发表报告。为了提高可靠性和有效性，我们根据《精神障碍诊断与统计手册》第 4 版物质戒断标准，主要为抗抑郁药停药或戒断“躁狂状态”制定了诊断标准。系统文献回顾确定了符合我们标准的 24 份报告。平均年龄为 39 岁（范围 18-74 岁），男女比例大致相当，更多的病例涉及单相（n=19）而非双相障碍（n=4）患者。抗抑郁药治疗前的中位持续时间为 12 周（范围 4 周-12 年）。所有主要的抗抑郁药类别都涉及其中（三环类抗抑郁药=13；选择性 5-羟色胺再摄取抑制剂=5；单胺氧化酶抑制剂=3；选择性 5-羟色胺-去甲肾上腺素再摄取抑制剂=2；其他=1）。更多的病例是在突然停药（n=11）后出现的，而不是逐渐停药（n=6）。有 6 例似乎符合《精神障碍诊断与统计手册》第 4 版躁狂发作的标准，其中 2 例需要住院治疗。在 24 例病例中，有 9 例未经治疗自发缓解（中位持续时间=25.5 天），6 例对抗躁狂药物有反应，4 例在重新使用抗抑郁药后缓解，5 例治疗情况不清楚。我们的结论是，抗抑郁药停药后轻躁狂/躁狂是一种有效的综合征。它应被添加到轻躁狂/躁狂的鉴别诊断中。讨论了其临床意义和可能的机制。
