Lebanese University, Faculty of Medical Sciences, Psychiatry Department, Beirut, Lebanon.
Lebanese University, Faculty of Medical Sciences, Psychiatry Department, Beirut, Lebanon.
J Affect Disord. 2018 Aug 1;235:551-556. doi: 10.1016/j.jad.2018.04.080. Epub 2018 Apr 16.
Antidepressant withdrawal manic states are intriguing and under-recognized phenomena. The associated patho-physiological pathways are ill defined and the inclusion of the phenomena in the bipolar spectrum disorders is questionable. This study aims to update a review on antidepressant discontinuation manic states published in 2008 and to look for hints alluding to bipolar disorder in the affected published cases and in the literature. It also reviews the different hypotheses proposed to explain discontinuation mania.
We searched Pubmed using the key words: 'antidepressant withdrawal' or 'antidepressant discontinuation' plus 'mania' or 'hypomania' from January 2008 until January 2018.
Five new eligible reports were identified since the last review in 2008, involving the antidepressants Amitriptyline, Fluoxetine, Escitalopram and Mirtazapine. Hypotheses involve the implication of Catecholamines, Acetylcholine and Serotonin in the pathophysiology of this paradoxical phenomenon. Careful analysis of the total 29 cases revealed psychiatric histories in favor of a bipolar spectrum disorder in 12 individuals while five were already known to have bipolar disorder.
This review is based on case reports with associated recall bias, and lack of in-depth description at times.
Antidepressant discontinuation manic or hypomanic states do not occur randomly. An individual susceptibility to bipolar disorder must be considered.
抗抑郁药戒断躁狂状态是一种有趣且未被充分认识的现象。其相关的病理生理途径尚未明确，并且将其纳入双相情感障碍谱障碍也存在疑问。本研究旨在更新 2008 年发表的关于抗抑郁药戒断躁狂状态的综述，并在已发表的病例和文献中寻找暗示双相情感障碍的线索。它还回顾了解释戒断性躁狂的不同假说。
我们使用关键词“antidepressant withdrawal”或“antidepressant discontinuation”加上“mania”或“hypomania”，在 2008 年 1 月至 2018 年 1 月期间在 Pubmed 上进行了搜索。
自 2008 年上一次综述以来，又确定了 5 项新的合格报告，涉及抗抑郁药阿米替林、氟西汀、依地普仑和米氮平。假说涉及儿茶酚胺、乙酰胆碱和 5-羟色胺在这种矛盾现象的病理生理学中的作用。对总共 29 例病例的仔细分析显示，有 12 例患者有精神病病史，支持双相情感障碍谱障碍，而 5 例患者已知患有双相情感障碍。
本综述基于病例报告，存在回忆偏倚，有时描述不够深入。
抗抑郁药戒断躁狂或轻躁狂状态并非随机发生。必须考虑个体对双相情感障碍的易感性。
