Management of Bipolar Disorder

Introduction to SSRIs and Mania

• SSRIs are contraindicated in acute mania because they can destabilize mood, exacerbate manic symptoms, or trigger a full manic episode by increasing serotonergic activity in an already hyperactive brain state, according to the American Academy of Child and Adolescent Psychiatry 1
• The American Academy of Child and Adolescent Psychiatry guidelines clearly state that antidepressants, including SSRIs, may destabilize a patient's mood or incite a manic episode, even when mood stabilizers are co-prescribed 1
• SSRIs can cause behavioral disinhibition, particularly problematic during acute mania when impulse control is already compromised, as stated by the American Academy of Child and Adolescent Psychiatry 1
• If SSRIs are necessary for bipolar depression, they should only be used as adjuncts to mood stabilizers, with careful monitoring for emergence of manic symptoms, as recommended by the American Academy of Child and Adolescent Psychiatry 1
• Failing to recognize SSRI-induced mania can lead to inappropriate treatment, as manic symptoms associated with SSRIs may represent either unmasking of bipolar disorder or direct medication-induced disinhibition, according to the American Academy of Child and Adolescent Psychiatry 1
• The DSM specifically classifies a manic episode precipitated by an antidepressant as "substance-induced", highlighting the causal relationship between SSRIs and manic symptoms, as stated by the American Academy of Child and Adolescent Psychiatry 1