Can antidepressant mono therapy in cyclothymic disorder cause full blown mania? Is that a sure sign of type 1 bipolar disorder?

Let’s start with a little diagnostic jargon. Officially, we use the term cyclothymic disorder to describe a mood pattern including both mild depression and hypomania—with neither severe enough to make a diagnosis of bipolar disorder. And we use the term bipolar disorder type 2 to refer to a mood pattern including both major depression and hypomania. Finally, we use the term bipolar disorder type 1 to refer to a mood pattern including both major depression and full mania. Full mania means that significant manic symptoms last at least 7 days or lead to hospitalization.

Antidepressant medications can certainly cause mania, especially if they are used alone (without a mood stabilizer or anti-manic medication). That can happen in people with no history of hypomania or mania—but this risk is higher in people with type 2 bipolar disorder and highest in people with type 1 bipolar disorder. In other words, a history of mania increases the odds that taking an antidepressant can bring on mania.

Officially, a manic episode brought on by taking an antidepressant would not add up to a diagnosis of bipolar disorder. But it would certainly identify someone at higher risk for having a manic episode in the future, with or without antidepressant medication. My advice to anyone who experienced mania after starting an antidepressant would be: You should make sure any doctor who wants to prescribe an antidepressant knows about this! Some people have used the term “type 3 bipolar disorder” for the pattern of depression with a manic episode that ONLY happened while taking antidepressants. But psychiatrists do like to name things!

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.