Switch to mania upon discontinuation of antidepressants in patients with mood disorders: A review of the literature
Switch to mania upon discontinuation of antidepressants in patients with mood disorders: A review of the literature
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DOI：
10.1177/070674370304800410
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发表时间：
2003-05-01
影响因子：
4
通讯作者：
Milev, R
中科院分区：
文献类型：
--
作者：
Ali, S;Milev, R
目的：回顾文献报道的案件躁狂症相关的抗抑郁药治疗中断，以及可能的解释这种现象，并提出一个case report.Method：我们进行了文献综述，通过PubMed索引，使用关键词躁狂症，抗抑郁药戒断，抗抑郁药在双相情感障碍。我们回顾了11篇文章，涉及23例病例。在可用的情况下，我们记录了双相情感障碍（BD）和单相抑郁症的某些参数并制成表格。结果：在单相抑郁症患者中，我们发现了17例报告的抗抑郁药戒断引起的躁狂症。涉及的抗抑郁药包括三环类抗抑郁药（TCA）（12/17）、单胺氧化酶抑制剂（MAOI）（2/17）、曲唑酮（1/17）、米氮平（1/17）和帕罗西汀（1/17）。对于BD患者，我们发现了19例报告的抗抑郁药戒断引起的躁狂症病例，包括我们自己的病例。其中，选择性5-羟色胺再摄取抑制剂（SSRIs）（10/19），TCAs（4/19），MAOIs（2/19），和5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）（2/19）是involved.Conclusion：我们的病例报告支持观察抗抑郁药撤药引起的躁狂症的BD患者。它与抗抑郁药引起的躁狂、生理性药物戒断和作为疾病自然过程的躁狂不同。人们提出了许多理论来解释这一现象。去甲肾上腺素能亢进和“戒断诱导的胆碱能兴奋和胆碱能-单胺能系统”是研究和支持最多的2种模型。前者受限于临床相关性差，后者受限于其仅适用于抗胆碱能药物。
Objective: To review the literature for reported cases of mania related to discontinuing antidepressant treatment, as well as for possible explanations of this phenomenon, and to present a case report.Method: We undertook a literature review through the PubMed index, using the key words mania, antidepressant withdrawal, and antidepressants in bipolar disorder. We reviewed 11 articles featuring 23 cases. Where available, we noted and tabulated certain parameters for both bipolar disorder (BD) and unipolar depression. We use a case example to illustrate the phenomenon of mania induced by antidepressant withdrawal.Results: For patients with unipolar depression, we found 17 reported cases of mania induced by antidepressant withdrawal. Antidepressants implicated included tricyclic antidepressants (TCAs) (12/17), monoamine oxidase inhibitors (MAOIs) (2/17), trazodone (1/17), mirtazapine (1/17), and paroxetine (1/17). For patients with BD, we found 19 reported cases of mania induced by antidepressant withdrawal, including our own case example. Of these, selective serotonin reuptake inhibitors (SSRIs) (10/19), TCAs (4/19), MAOIs (2/19), and serotonin norepinephrine reuptake inhibiors (SNRIs) (2/19) were implicated.Conclusion: Our case report supports the observation of antidepressant withdrawal-induced mania in patients with BD. It is distinguishable from antidepressant-induced mania, physiological drug withdrawal, and mania as a natural course of the illness. Many theories have been put forward to explain this occurrence. Noradrenergic hyperactivity and "withdrawal-induced cholinergic overdrive and the cholinergic-monoaminergic system" are the 2 most investigated and supported models. The former is limited by poor clinical correlation and the latter by its applicability only to anticholinergic drugs.