Sertraline-Induced Mania

Mechanism and Risk Factors

Sertraline can cause behavioral activation/agitation, including motor restlessness, insomnia, impulsiveness, talkativeness, disinhibited behavior, and aggression, which can be difficult to distinguish from mania/hypomania, according to the American Academy of Child and Adolescent Psychiatry 1, 2
Previous episodes of antidepressant-induced mania are a risk factor that may predispose patients to sertraline-induced mania, as reported by the American Academy of Child and Adolescent Psychiatry 3

Manic symptoms that may emerge after sertraline initiation include increased energy, decreased need for sleep, pressured speech, racing thoughts, impulsivity, and disinhibited behavior, as described by the American Academy of Child and Adolescent Psychiatry 1

Behavioral activation typically occurs early in treatment or with dose increases and improves quickly after SSRI dose decrease or discontinuation, whereas true mania/hypomania may appear later in treatment course and persists despite medication discontinuation, according to the American Academy of Child and Adolescent Psychiatry 1

Starting with lower doses in patients without established tolerance is recommended, as suggested by the American Academy of Child and Adolescent Psychiatry 2