Q: What Antidepressant is Least Likely to Cause Mania
Dear Dr. Phelps; I have read your archived questions and did not really see the answer I'm looking for . My daughter is a
rapid cycler and currently on zyprexa , ( 10 mgs. ) and was
on effexor and was having break thru mania and slowly has
been discontinuing it . She has never been on an antidepressant
that didnt make her
manic but this time I had hopes it
would work for her because she has never been on a mood stabilizer and
antidepressant together. She has tried lithium and is allergic to it,
and complained that she felt strange on both depakote and tegretol . The zyprexa seems
to help reduce her cycling but she has severe anxiety and though
her depression is better, it is still bothering her. I want to
know if there is an antidepressant that is the least likely to cause
mania and if the
addition of another mood stabilizer would help her. Thank You ,
Dear Ms. T' --
There are several facets to your question. First, is there an
antidepressant least likely to exacerbate mood cycling (including causing
manic symptoms)? Most experts seem to agree that Wellbutrin is the least
likely of routinely used antidepressants to do this. The class of
medications called "MAOI's" (monoamine oxidase inhibitors) may be
even less likely, but are not at all easy to use (one can't eat cheese, for
Second, would another mood
stabilizer help? That's almost certainly what I would do.
Especially because, and this is item 3, she still has "manic-side"
symptoms, namely the anxiety. I always avoid adding an antidepressant if
a person has any "manic-side" symptoms already present, as they
almost always seem to get worse and one must back off the antidepressant and
then start all over.
lamotrigine as a mood stabilizer with antidepressant activity.
Published August, 2001