Re: Did abruptly discontinuing ADs make you manic?

Here are some case reports about mania because of discontinuing of antidepressants:
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J Psychosoc Nurs Ment Health Serv. 2010 Jul;48(7):9-12. doi: 10.3928/02793695-20100527-98. Epub 2010 Jun 22.
Potential adverse effects of discontinuing psychotropic drugs: part 2: antidepressant drugs.
Howland RH.
Source
University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. HowlandRH@upmc.edu
Abstract
Understanding the particular pharmacology of different antidepressant drugs can help explain their adverse effects when they are discontinued. For all antidepressant drugs, abruptly stopping them can sometimes result in "rebound" hypomania or mania.
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http://www.ncbi.nlm.nih.gov/pubmed/20156925
J Psychopharmacol. 2011 Mar;25(3):306-13. doi: 10.1177/0269881109359094. Epub 2010 Feb 15.
Antidepressant discontinuation manic states: a critical review of the literature and suggested diagnostic criteria.
Narayan V, Haddad PM.
Source
Cromwell House Community Mental Health Centre, Manchester, UK.
Abstract
We critically appraised all published reports of hypomania and mania following antidepressant termination. To increase reliability and validity we devised diagnostic criteria for an antidepressant discontinuation or withdrawal 'manic state' based primarily on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition substance withdrawal criteria. A systematic literature review identified 24 reports meeting our criteria. Mean age was 39 years (range 18-74), men and women were approximately equally represented, and more cases involved people with unipolar (n = 19) than bipolar disorder (n = 4). The median duration of preceding antidepressant treatment was 12 weeks (range 4 weeks-12 years). All major antidepressant classes were involved (tricyclic antidepressants = 13; selective serotonin reuptake inhibitors = 5; monoamine oxidase inhibitors = 3; selective serotonin-norepinephrine reuptake inhibitors = 2; miscellaneous = 1). More cases followed abrupt antidepressant withdrawal (n = 11) than a tapered withdrawal (n = 6). Six cases appeared to meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition for a manic episode, with two cases requiring inpatient admission. Of the 24 cases, nine resolved spontaneously without treatment (median duration = 25.5 days), six responded to antimanic drugs, four resolved following antidepressant reinstatement, and treatment was unclear in five cases. We conclude that antidepressant discontinuation hypomania/mania is a valid syndrome. It should be added to the differential diagnosis of hypomania/mania. The clinical implications and possible mechanisms are discussed.
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http://www.ncbi.nlm.nih.gov/pubmed/18791886

Turk Psikiyatri Derg. 2008 Fall;19(3):329-33.
[Hypomania/mania induced by cessation of antidepressant drugs].
[Article in Turkish]
Kora K, Kaplan P.
Source
koralar@superonline.com
Abstract
Although rarely reported, the induction of hypomanic/manic episodes due to sudden or gradual cessation of antidepressant drugs is a phenomenon observed in clinical settings. Herein we present 2 patients that had manic episodes induced by gradual cessation of antidepressant drugs. Common features of both cases were as follows: patients were female; a major depressive episode was the reason for starting treatment; familial loading for unipolar depressive disorder; venlafaxine was administered for treatment of the episode; mood elevation symptoms while gradually decreasing the medication dose; absence of physical symptoms related to withdrawal; antipsychotic and mood stabilizing drugs were required for the treatment of the episode. In both cases 1) a hypomanic/manic episode induced by the use of antidepressants, 2) agitated depression, 3) physical withdrawal syndrome, and 4) spontaneous episodes in the natural course of the illness were the 4 different states that were taken into consideration for differential diagnosis. Hypomanic/manic episodes induced by cessation of antidepressant drugs are thought to shed light on the etiology of bipolar disorder, which this report discusses with reference to the case reports.
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http://www.ncbi.nlm.nih.gov/pubmed/15291689

J Clin Psychiatry. 2004 Jul;65(7):987-93.
Antidepressant-withdrawal mania:a critical review and synthesis of the literature.
Andrade C.
Source
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India. andrade@nimhans.kar.nic.in
Abstract
BACKGROUND:
Hypomania or mania have rarely been reported to develop shortly after the discontinuation of an antidepressant drug. The true incidence of this discontinuation syndrome is unknown because it may be underreported as a consequence of underrecognition or misattribution. This article examines the possible etiology, nosology, mechanisms, and other aspects of the syndrome.
DATA SOURCES AND STUDY SELECTION:
A PubMed search was conducted in May 2003 and repeated in January 2004 using the search terms antidepressant and mania. Relevant articles containing adequate descriptions for presentation were retrieved, and their reference lists were hand-searched for further pertinent material. Hand-searches of the indexes of leading psychiatry journals were also performed for the years 1998-2003. Twenty-three articles were identified for review.
CONCLUSIONS:
Antidepressant-withdrawal hypomania or mania may occur rarely with almost any antidepressant drug after sudden withdrawal, tapered discontinuation, or even merely a decrease in dose. The syndrome may be self-limiting, may abate with the reinstitution of the antidepressant drug, or may require specific anti-manic treatments; mood stabilizers do not necessarily protect against the syndrome. The true incidence of the syndrome is unknown. Narrow and broad diagnostic criteria are proposed for the syndrome, and a synthesis of literature is provided.
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Excerpt from the article "Can Long-Term Treatment With Antidepressant Drugs Worsen the Course of Depression?" by Giovanni A. Fava, M.D.:

We know that discontinuation of antidepressant drugs may trigger hypomania or mania81,82 despite adequate con-comitant mood-stabilizing treatment.83 Furthermore, mood shifts to euthymia or hypomania are not rare events in patients withdrawn from medication because of a lack
of efficacy.84 Mood elevation may also occur with anti-depressant dose decrease,85 and patients who failed to re-spond to mood stabilizers in combination with antide-pressant drugs may improve on discontinuation of the
antidepressant drugs. 86

These data suggest a relationship between antidepressant drug discontinuation and cycle acceleration in bipolar disorder. 83 In unipolar depression, withdrawal phenomena may be associated with recur-
rence acceleration.

81. Mirin SM, Schatzberg AF, Creasey DE. Hypomania and mania after
withdrawal of tricyclic antidepressants. Am J Psychiatry 1981;138:8789

82. Landry P, Roy L. Withdrawal hypomania associated with paroxetine
[letter]. J Clin Psychopharmacol 1997;17:6061

83. Goldstein TR, Frye MA, Denicoff KD, et al. Antidepressant
discontinuation-related mania: critical prospective observation and
theoretical implications in bipolar disorder [CME]. J Clin Psychiatry
1999;60:563567

84. McGrath PJ, Stewart JW, Tricamo E, et al. Paradoxical mood shifts
to euthymia or hypomania upon withdrawal of antidepressant agents.
J Clin Psychopharmacol 1993;13:224225

85. Corral M, Sivertz K, Jones BD. Transient mood elevation associated
with antidepressant drug decrease. Can J Psychiatry 1987;32:764767

86. Sharma V. Loss of response to antidepressants and subsequent
refractoriness. J Affect Disord 2001;64:99106

J Clin Psychopharmacol. 1985 Dec;5(6):340-2.
Mania after withdrawal of isocarboxazid.
Rothschild AJ.
Abstract
Two cases of mania following the discontinuation of treatment with isocarboxazid are described. Although this phenomenon has been reported by several investigators to occur after cessation of tricyclic antidepressant therapy, there exists only one isolated report of hypomania after discontinuation of monoamine oxidase inhibitors. Possible mechanisms for the occurrence of hypomania and mania after withdrawal from antidepressants are discussed.
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Do the case reports above seem familiar to you?

In my opninion, it is possible to have hypomanic or manic reactions to antidepressants without being bipolar. (A professor in pharmacotherapy I called many years ago confirmed that SSRIs could cause euphoria in the absence of bipolar disorder.) If antidepressants are the only thing that makes you manic, I think it could be that you still are unipolar.

In 1994 and 1995 I was diagnosed with manic depressive psychosis/bipolar disorder, but the mania was caused by paroxetine. The first time I become manic was in 1994, when my paroxetine dose was changed from 20 to 60 mg from one day to another. I have never been manic in the absence of antidepressants. My main diagnosis was later changed to recurrent depression.

It was one psychiatrist though who concluded (in 1997, I think) that I may was bipolar, but that only a special provocation could cause mania, such as abrubt changes of antidepressants.

What do you think about this, and have you ever become hypomanic or manic when you have stopped taking antidepressants?

Earlier TRD/anxiety
300 mg tianeptine, 6 X 50 mg successfully since Oct 2009
20 mcg liothyronine
40 mg escitalopram
100 mg trimipramine
50 mg agomelatine
600 mg quetiapine

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