How Long Does Mania Triggered by an AD Last?
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Q:  How Long Does Mania Triggered by an AD Last?

Dr. Phelps,

How long can mania last when it was induced with paxil. My wife doctor did not inform us about mania, so I was caught off guard and my wife seem to be in a state of mania for almost 2 months before it came a huge problem and notfied my wife doctor.

she is now being tapered of paxil 10mg. every other day.(she was only taking 12.5 before) She has left the house and I don't know where she's staying. Dose antidepresant induced mania remit side by side with the tapering process? Also is there any diffrent charirizteics with this type of mania.

Thank You,

Dear Brett -- 
I hope by the time you read this that things are settling down; it sounds mighty rough right now.  Unfortunately, in many cases a manic phase apparently triggered by a antidepressant can persist long after the AD is removed, as much as weeks or occasionally months. So unfortunately I think it is more likely that her symptoms will persist for a while than that they'll stop as soon as the Paxil is stopped. On the other hand, there could have been many patients whose antidepressant-induced mania went away so fast that I never saw them or heard about them, so my estimates could be off by a lot.  But in my patients, I gear up for a period approximating the usual length of their manic phases. If she's never had one before, then obviously there's nothing to go by there in her case.  

Fortunately many of our current treatments for mania can work very fast, though, so if she is in treatment, this could be brought under control rapidly. If for example she would consent to a hospital stay, there they can go faster with dose increases and bring symptoms under control in a few days to a week in most cases. We generally reserve that approach for people whose symptoms require going fast, either great suffering or potential dangerousness. 

As for your other question, no, the mania that comes with antidepressants (or hypomania, in people with Bipolar II) does not appear to be any different from those symptoms when they've "gotten there on their own".  Good luck with all this. 

Dr. Phelps

June, 2005 


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