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By Anne Harding
NEW YORK, Mar 20 (Reuters Health) - While newer antidepressants are safer than older drugs, they still not risk-free--particularly for people that have more complex mental illnesses, Yale University psychiatrists show in a new study.
In a study of patients admitted to Yale-New Haven Psychiatric Hospital in Connecticut, 43 out of 533 cases were due to psychosis or mania related to the use of antidepressants. Thirty of these patients, or 70%, were taking selective serotonin reuptake inhibitors (SSRIs), including sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox) and fluoxetine (Prozac).
Psychosis is a severe mental disorder characterized by loss of contact with reality and mania is an abnormally elevated mood accompanied by disorganized behavior, euphoria, excessive energy and sleeplessness.
Psychiatrists have known since the 1950s that antidepressant drugs can produce manic or psychotic behavior in some patients. While SSRIs are in many ways safer than older antidepressants, these drugs can still trigger mania and psychosis, Dr. Adrian Preda and colleagues write in the January issue of the Journal of Clinical Psychiatry.
And the number of prescriptions written for antidepressant drugs has doubled since 1985, largely because of the relative safety of SSRIs. Preda and colleagues note that this increase means more people are at risk.
Many of the affected patients had a history of mental illness other than depression. Among the patients admitted to the hospital, 26 (61%) had a history of psychosis. Psychotic symptoms occur in various mental disorders such as schizophrenia, with hallucinations and delusions being two common symptoms.
"We do not think our data should be interpreted as showing that SSRIs are more likely than other antidepressants to be associated with mania or psychosis in susceptible individuals," the authors write. "Rather, the number of cases of mania or psychosis during SSRI treatment very likely reflects the increased use of these drugs generally."
While antidepressants are unlikely to produce mania in people with simple depression, Dr. Lauren Marangell told Reuters Health, these drugs can bring on mania and psychosis in people with bipolar disorder. Marangell is director of mood disorders research and director of clinical psychopharmacology at Baylor College of Medicine in Houston, Texas.
Bipolar disorder, or manic-depressive illness, is characterized by dramatic, cyclical mood swings from depression to mania and back.
While people may feel energetic and creative in the early stages of mania, this state, if left untreated, can progress into a person's not needing any sleep and becoming psychotic, she added. "These people will often believe that they're God."
While depression affects 10% of the US population during any given year, bipolar disorder is more rare, striking 1% of Americans, according to the National Institute of Mental Health.
Bipolar disorder and depression are two different conditions, Marangell noted, but the depressed phase of bipolar disorder can look just like depression. This is when a person is at risk of being prescribed antidepressants. The gold standard of treatment for bipolar disorder, said Marangell, is lithium, which may be given along with antidepressants or alone.
Because antidepressants can bring on mania in people with bipolar disorder, Marangell warned, it is crucial for doctors to understand how to diagnose this condition. People themselves should be aware if they have a history of bipolar disorder in their family, she added, because this increases their risk of developing the condition.
SOURCE: Journal of Clinical Psychiatry 2001;62:30-33.
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