A review of antidepressant-induced hypomania in major depression: suggestions for DSM-V


David L Dunner MD, University of Washington, Department of Psychiatry and Behavioral Science, Center for Anxiety and Depression, 4225 Roosevelt Way NE, Suite 306C, Seattle, WA 98105-6099, USA. Fax: 206 543 7565;
e-mail: ddunner@u.washington.edu


Objectives:  To determine if the classification of ‘antidepressant-induced hypomania’ in DSM-IV is supported by available data.

Methods:  We reviewed the available scientific literature to examine the incidence of mania and hypomania in non-bipolar patients who were treated with antidepressants.

Results:  Eighty-nine per cent of studies of antidepressants in major depressive disorder patients reported no cases of treatment-induced hypomania. No instances of treatment-induced hypomania were reported in three large studies of patients with chronic forms of depression.

Conclusions:  The rate of antidepressant-induced hypomania in major depressive disorder is within the rate of misdiagnosis of bipolar depression as unipolar. Depressed patients who experience antidepressant-associated hypomania are truly bipolar.