Manic states related to antidepressant withdrawal – a case report and literature review

Abstract

A manic state induced by antidepressant withdrawal is a rare clinical occurrence that has been increasingly reported in the last decades and currently represents a nosological entity with specified criteria. Objectives: This paper aims to report a case of mania induced by escitalopram withdrawal in a patient with unipolar depression. Furtherly, we intend to review the published case reports of manic states induced by antidepressant withdrawal, analysing its epidemiology and discussing the current theories concerning its pathophysiology. Methods: We conducted a search in PubMed database in July 2019, without restriction by year of publication, and selected case reports and literature reviews in English, which were fully read. Results: Only 29 reported cases fulfil the most accepted diagnostic criteria. This phenomenon is more frequent in patients with unipolar depression, may occur with any major class of antidepressant and it is still unclear whether it indicates a latent bipolar disorder. Our case report is the third case associated with the use of escitalopram published in the literature. Conclusion: Although a rare phenomenon, mania induced by antidepressant withdrawal poses relevant clinical challenges and its possible pathophysiological processes may shed some light on the mechanisms underlying affective disorders.