Original Research

Risk of manic switch with antidepressants use in patients with bipolar disorder in a Nigerian neuropsychiatric hospital

Ayodele L. Fela-Thomas, Osasu S. Olotu, Oluyomi Esan
South African Journal of Psychiatry | Vol 24 | a1215 | DOI: https://doi.org/10.4102/sajpsychiatry.v24i0.1215 | © 2018 Ayodele Lucy Fela-Thomas, Ayodele Lucy Fela-Thomas, Osasu Sunday Olotu, Oluyomi Esan | This work is licensed under CC Attribution 4.0
Submitted: 03 March 2018 | Published: 06 November 2018

About the author(s)

Ayodele L. Fela-Thomas, Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Nigeria
Osasu S. Olotu, Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Nigeria
Oluyomi Esan, Department of Psychiatry, University of Ibadan, Nigeria

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Background: Depressive disorders are common among those with bipolar affective disorder (BAD) and may necessitate the use of antidepressants. This has been suggested to precipitate manic episodes in some patients.

Objectives: This study aims to determine the prevalence of and factors associated with manic switch in patients with BAD being treated with antidepressants.

Methods: Case notes of patients who were treated at a Nigerian neuropsychiatric hospital for a BAD from 2004 to 2015 were reviewed. BAD diagnosis was made using ICD-10 criteria. Treatment for bipolar depression included monotherapy (i.e. antidepressants, antipsychotics or mood stabilisers) or combination therapy (mood stabiliser with an antidepressant or a combination of mood stabilisers, antipsychotics and antidepressants). The primary outcome measure was a switch to mania or hypomania within 12 weeks of commencing an antidepressant.

Results: Manic or hypomanic switch (MS) was observed in 109 (44.3%) of the participants. Female gender, younger age, number of previous episodes and a past history of psychiatric hospitalisation were all significantly associated with a risk of MS. There was no significant difference in the rate of MS in either those treated with adjunct antidepressants therapy with a mood stabiliser or an antipsychotic or those placed on a combination of antidepressants, antipsychotics and mood-stabilising agents.

Conclusion: A large proportion of patients with BAD on antidepressants experience medication-induced manic or hypomanic switch.


Bipolar disorder; Antidepressants; Manic or Hypomanic Switch


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