Download PDF
Pharmacopsychiatry 2015; 48(03): 83-88
DOI: 10.1055/s-0034-1396802
Review
© Georg Thieme Verlag KG Stuttgart · New York

Low Risk for Switch to Mania during Treatment with Sleep Promoting Antidepressants

A. Wichniak
1   Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
,
M. Jarkiewicz
1   Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
,
Ł. Okruszek
2   Department of Neuropsychology, Faculty of Psychology, University of Warsaw, Warsaw, Poland
,
A. Wierzbicka
3   Sleep Disorders Center, Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
,
J. Holka-Pokorska
1   Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
,
J. K. Rybakowski
4   Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
› Author Affiliations
Further Information

Publication History

received 16 October 2014
revised 14 November 2014

accepted 18 November 2014

Publication Date:
19 January 2015 (online)

Also available at
   Permissions and Reprints

Abstract

Introduction: Sleep-promoting antidepressants are of interest because they are used not only as antidepressants, but also to promote sleep.

Methods: We reviewed case reports describing the switch to mania during treatment with trazodone, mirtazapine, or agomelatine.

Results: Trazodone, mirtazapine, and agomelatine may induce manic symptoms. However, the risk of switching is related, first of all, to doses recommended for antidepressant treatment, administered without mood-stabilizer co-therapy. Low doses of these antidepressants, used for their hypnotic or sedative effects, were observed to cause mania only in patients with other risk factors for switching. There is no evidence for trazodone or mirtazapine and only sparse evidence for agomelatine, claiming that treatment with these antidepressants is related to an increased risk of switching to mania when administered in combination with a mood stabilizer.

Discussion: These findings suggest that low doses of trazodone and mirtazapine are safe in bipolar disorder, and should still be considered important alternatives to hypnotics when long-term pharmacological treatment of insomnia is necessary. It seems that these antidepressants and agomelatine can also be used safely in antidepressant doses when combined with a mood stabilizer.

Key words

bipolar disorder - switch to mania - antidepressants - trazodone - mirtazapine - agomelatine
 

  • References

  • 1 Pacchiarotti I, Bond DJ, Baldessarini RJ et al. The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders. Am J Psychiatry 2013; 170: 1249-1262
    CrossrefPubMedGoogle Scholar
  • 2 Post RM, Altshuler LL, Leverich GS et al. Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline. Br J Psychiatry 2006; 189: 124-131
    CrossrefPubMedGoogle Scholar
  • 3 Sachs GS, Lafer B, Stoll AL et al. A double-blind trial of bupropion versus desipramine for bipolar depression. J Clin Psychiatry 1994; 55: 391-393
    PubMedGoogle Scholar
  • 4 Rybakowski JK, Koszewska I, Puzynski S. Anticholinergic mechanisms: a forgotten cause of the switch process in bipolar disorder. J Clin Psychiatry 2010; 71: 1698-1699
    PubMedGoogle Scholar
  • 5 Koszewska I, Rybakowski JK. Antidepressant-induced mood conversions in bipolar disorder: a retrospective study of tricyclic versus non-tricyclic antidepressant drugs. Neuropsychobiology 2009; 59: 12-16
    CrossrefPubMedGoogle Scholar
  • 6 Wichniak A, Wierzbicka A, Jernajczyk W. Sleep and antidepressant treatment. Curr Pharm Des 2012; 18: 5802-5817
    CrossrefPubMedGoogle Scholar
  • 7 Ng TH, Chung KF, Ho FY et al. Sleep-wake disturbance in interepisode bipolar disorder and high-risk individuals: A systematic review and meta-analysis. Sleep Med Rev. 2014
    PubMedGoogle Scholar
  • 8 Wichniak A, Wierzbicka A, Jernajczyk W. Sleep as a biomarker for depression. Int Rev Psychiatry 2013; 25: 632-645
    CrossrefPubMedGoogle Scholar
  • 9 Wilson SJ, Nutt DJ, Alford C et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol 2010; 24: 1577-1601
    CrossrefPubMedGoogle Scholar
  • 10 Stahl SM. Mechanism of action of trazodone: a multifunctional drug. CNS Spectr 2009; 14: 536-546
    PubMedGoogle Scholar
  • 11 Arana GW, Kaplan GB. Trazodone-induced mania following desipramine-induced mania in major depressive disorders. Am J Psychiatry 1985; 142: 386
    PubMedGoogle Scholar
  • 12 Escobar JI, Gomez J, Constain C et al. Controlled clinical trial with trazodone, a novel antidepressant. A South American experience. J Clin Pharmacol 1980; 20: 124-130
    CrossrefPubMedGoogle Scholar
  • 13 Jabeen S, Fisher CJ. Trazodone-induced transient hypomanic symptoms and their management. Br J Psychiatry 1991; 158: 275-278
    CrossrefPubMedGoogle Scholar
  • 14 Knobler HY, Itzchaky S, Emanuel D et al. Trazodone-induced mania. Br J Psychiatry 1986; 149: 787-789
    CrossrefPubMedGoogle Scholar
  • 15 Lennhoff M. Trazodone-induced mania. J Clin Psychiatry 1987; 48: 423-424
    PubMedGoogle Scholar
  • 16 Theilman SB, Christenbury MM. Hypomania following withdrawal of trazodone. Am J Psychiatry 1986; 143: 1482-1483
    PubMedGoogle Scholar
  • 17 Warren M, Bick PA. Two case reports of trazodone-induced mania. Am J Psychiatry 1984; 141: 1103-1104
    CrossrefPubMedGoogle Scholar
  • 18 Zmitek A. Trazodone-induced mania. Br J Psychiatry 1987; 151: 274-275
    CrossrefPubMedGoogle Scholar
  • 19 Horiguchi T, Sai S. A display of hypomania in a depressed male in response to fluvoxamine. World J Biol Psychiatry 2001; 2: 201-204
    CrossrefPubMedGoogle Scholar
  • 20 Hilleret H, Jeunet E, Osiek C et al. Mania resulting from continuous positive airways pressure in a depressed man with sleep apnea syndrome. Neuropsychobiology 2001; 43: 221-224
    CrossrefPubMedGoogle Scholar
  • 21 Rachid F, Golaz J, Bondolfi G et al. Induction of a mixed depressive episode during rTMS treatment in a patient with refractory major depression. World J Biol Psychiatry 2006; 7: 261-264
    CrossrefPubMedGoogle Scholar
  • 22 Haggerty Jr JJ, Jackson R. Mania following change from trazodone to imipramine. J Clin Psychopharmacol 1985; 5: 342-343
    CrossrefPubMedGoogle Scholar
  • 23 de Boer T. The effects of mirtazapine on central noradrenergic and serotonergic neurotransmission. Int Clin Psychopharmacol 1995; 10 (Suppl. 04) 19-23
    PubMedGoogle Scholar
  • 24 Basavraj V, Nanjundappa GB, Chandra PS. Mirtazapine induced mania in a woman with major depression in the absence of features of bipolarity. Aust N Z J Psychiatry 2011; 45: 901
    CrossrefPubMedGoogle Scholar
  • 25 Habermeyer B, Bayer U, Muller-Spahn F. Mania associated with mirtazepine treatment and mixed depression. Pharmacopsychiatry 2010; 43: 37-38
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Liu CC, Liang KY, Liao SC. Antidepressant-associated mania: soon after switch from fluoxetine to mirtazapine in an elderly woman with mixed depressive features. J Psychopharmacol 2009; 23: 220-222
    PubMedGoogle Scholar
  • 27 Ng B. Mania associated with mirtazapine augmentation of fluoxetine. Depress Anxiety 2002; 15: 46-47
    CrossrefPubMedGoogle Scholar
  • 28 Prost E, Abraham G. Mirtazapine-induced shopping spree. Can J Psychiatry 2004; 49: 495
    PubMedGoogle Scholar
  • 29 Bhanji NH, Margolese HC, Saint-Laurent M et al. Dysphoric mania induced by high-dose mirtazapine: a case for ‘norepinephrine syndrome’?. Int Clin Psychopharmacol 2002; 17: 319-322
    CrossrefPubMedGoogle Scholar
  • 30 De Leon OA, Furmaga KM, Kaltsounis J. Mirtazapine-induced mania in a case of poststroke depression. J Neuropsychiatry Clin Neurosci 1999; 11: 115-116
    CrossrefPubMedGoogle Scholar
  • 31 Goyal N, Sinha VK. Mirtazapine-induced manic switch in adolescent unipolar depression. Aust N Z J Psychiatry 2008; 42: 1070-1071
    PubMedGoogle Scholar
  • 32 Soutullo CA, McElroy SL, Keck Jr PE. Hypomania associated with mirtazapine augmentation of sertraline. J Clin Psychiatry 1998; 59: 320
    CrossrefPubMedGoogle Scholar
  • 33 MacCall C, Callender J. Mirtazapine withdrawal causing hypomania. Br J Psychiatry 1999; 175: 390
    PubMedGoogle Scholar
  • 34 Hickie IB, Rogers NL. Novel melatonin-based therapies: potential advances in the treatment of major depression. Lancet 2011; 378: 621-631
    CrossrefPubMedGoogle Scholar
  • 35 Tu KY, Lin PY. Hypomania soon after shifting from paroxetine to agomelatine in a middle-aged woman with depression. Clin Neuropharmacol 2014; 37: 82-83
    CrossrefPubMedGoogle Scholar
  • 36 Calabrese J, Guelfi JD, Perdrizet-Chevallier C. Agomelatine adjunctive therapy for acute bipolar depression: preliminary open data. Bipolar Disord 2007; 9: 628-635
    CrossrefPubMedGoogle Scholar
  • 37 Terao T. Comparison of manic switch onset during fluoxetine and trazodone treatment. Biol Psychiatry 1993; 33: 477-478
    CrossrefPubMedGoogle Scholar
  • 38 Viktorin A, Lichtenstein P, Thase ME et al. The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer. Am J Psychiatry 2014; 171: 1067-1073
    CrossrefPubMedGoogle Scholar
  • 39 Rodrigues AA, Rosa AR, Kunz M et al. Bipolar disorder: staging and neuroprogression. Psychiatr Pol 2014; 48: 231-243
    PubMedGoogle Scholar
  • 40 Kasprzak M, Kiejna A. Research on the role of life events in bipolar disorder. Psychiatr Pol 2013; 47: 875-885
    PubMedGoogle Scholar
  • 41 Montgomery SA. Safety of mirtazapine: a review. Int Clin Psychopharmacol 1995; 10 (Suppl. 04) 37-45
    CrossrefPubMedGoogle Scholar
  • 42 Gao K, Kemp DE, Ganocy SJ et al. Treatment-emergent mania/hypomania during antidepressant monotherapy in patients with rapid cycling bipolar disorder. Bipolar Disord 2008; 10: 907-915
    CrossrefPubMedGoogle Scholar
  • 43 Sidor MM, MacQueen GM. An update on antidepressant use in bipolar depression. Curr Psychiatry Rep 2012; 14: 696-704
    CrossrefPubMedGoogle Scholar
  • 44 Stahl SM. Enhancing outcomes from major depression: using antidepressant combination therapies with multifunctional pharmacologic mechanisms from the initiation of treatment. CNS Spectr 2010; 15: 79-94
    PubMedGoogle Scholar
  • 45 Kunzel HE, Ackl N, Hatzinger M et al. Outcome in delusional depression comparing trimipramine monotherapy with a combination of amitriptyline and haloperidol – a double-blind multicenter trial. J Psychiatr Res 2009; 43: 702-710
    CrossrefPubMedGoogle Scholar
  • 46 Riemann D, Voderholzer U, Cohrs S et al. Trimipramine in primary insomnia: results of a polysomnographic double-blind controlled study. Pharmacopsychiatry 2002; 35: 165-174
    Google Scholar
  • 47 Wiegand MH. Antidepressants for the treatment of insomnia: a suitable approach?. Drugs 2008; 68: 2411-2417
    CrossrefPubMedGoogle Scholar
  • 48 Bond DJ, Hadjipavlou G, Lam RW et al. The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid attention-deficit/hyperactivity disorder. Ann Clin Psychiatry 2012; 24: 23-37
    PubMedGoogle Scholar