Can J Psychiatry 2005;50:77-8. Mania is a distinct period of abnormal and sustained elevated, expansive, or irritable mood and increase in goal-directed activity or energy that lasts at least 1 week and is present for most of each day. J Affect Disord. After steroids are discontinued, depressive symptoms persist approximately 4 weeks, mania 3 weeks, and delirium a few days. Wyszynski AA, Wyszynski B. Positive and Negative Aspects of Hypomania, Hypomania highlights the fuzzy line between normal positive experiences, control hypomania explain that they rely on a few key strategies, Impulsivity and Bipolar Disorder: 5 Skills That Can Help, A Psychiatrist's Take on Bipolar Disorder, The Importance of Schedule Regularity in Bipolar Disorder, Bipolar Disorder and the Challenges of Widely Fluctuating Moods, Fragile Brilliance: The Troubled Life of Herman Melville, Bipolar Disorder: How to Get Correctly Diagnosed. A number of people with bipolar disorder especially those with a history of severe manic episodes experience a breakdown in their marriages. Feeling easily distracted. Pauleywho had no history of bipolar disorderspent 3 weeks in a New York psychiatric hospital.1. Corticosteroids psychiatric effectscognitive, mood, anxiety, and psychotic symptomswere first described as steroid psychosis. Psychosis can occur, but mood symptoms are more common: Steroid-induced symptoms emerge from 3 to 4 days to a median of 11 days after a patient starts corticosteroid therapy. Can Humans Detect Text by AI Chatbot GPT? [3] J Affect Disord 1983;5:319-32. Herbal supplements: Can they cause hypomania? Impact of the DSM-IV to DSM-5 changes on the national survey on drug use and health [Internet]. Remember hypomania can be really destructive and cause a lot of problems - not to mention it can lead to full blown mania which often ends up with a stay in hospital. Steroid-induced psychiatric syndromes. Sirois F. Steroid psychosis: a review. 18-For the diagnosis of bipolar II disorder, a person must have experienced both a ___ and a ___. I told everyone that I could understand why men felt like they could run the world, because I felt like that. Washington (DC): American Psychiatric Press; 1997. PMID:30847440, Yamaguchi Y, Kimoto S, Nagahama T, Kishimoto T. Dosage-related nature of escitalopram treatment-emergent mania/hypomania: a case series. One may think that one is accomplishing a lot when hypomanic, but hypomania impairs one's cognition, insight and judgment to such a degree that one is often unaware that they are actually in a hypomanic state. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. People already living with bipolar disorder are more likely to experience a sudden episode of mania after taking certain antidepressants. A hypothesis, A review of antidepressant-induced hypomania in major depression: suggestions for DSM-V, Doseresponse relationship of selective serotonin reuptake inhibitors treatment- emergent hypomania in depressive disorders, Treatment-induced manic switch in the course of unipolar depression can predict bipolarity: Cluster analysis based evidence, Antidepressant-induced hypomania/mania in patients with major depression: evidence from the BRIDGE-II-MIX study, Meta-analysis of the interval between the onset and management of bipolar disorde, One-year outcomes of unipolar depression patients with manic or hypomanic switch during acute antidepressant treatment. 10. Bipolar disorder is also strongly associated with postpartum psychosis, a severe mental illness characterized by an inability to respond emotionally to one's newborn, or by thoughts of harming one's baby, according to the Cleveland Clinic. It's also important to rule out medications or recreational substance use as a possible source of the symptoms before making a diagnosis of hypomania. Br J Psychiatry 1994;164:109-11. This is always a bad idea. Navarro V, Gast C, Guarch J, Penads R, Pintor L.Treatment and outcome of antidepressant treatment associated hypomania in unipolar major depression: a 3-year follow-up study. J Neuropsychiatry Clin Neurosci 1989;1:398-400. There has been evidence of SAMe inducing a switch (euphoria, hypomania, or mania) at a rate of 33% in 9 patients. Learn more about seasonal bipolar disorder and how to cope. A hypomanic episode is a distinct period of time in which these marked changes from a persons baseline mood and energy are apparent. There are many factors which contribute to hypomania. 16. Inside Bipolar Podcast: Is Happiness Possible with Bipolar? She has a passion for human rights activism and is the author of Behind the Burqa (John Wiley, 2002), a memoir of 2 Afghan sisters who escaped Afghanistan. Psychosomatics 1993;34:173-7. This podcast episode asks a serious question. You don't make sound decisions. Did You Know Anxiety Can Enhance Our Relationships? CNS Spectr. Trust me, as I've had a caffeine addiction where I'd drink a 12 pack of soda 2 cups of coffee (did I mention the cups were 2 large's from D&D) and then alot of caffinated tea just to maintain my manic states to not become depressed. Improving the nosological clarity of AAH should assist with clinical decision-making., 1. This occurs when someone whose bipolar symptoms are stable attends a funeral and develops a manic episode over the course of the following week. Tondo L, Vazquez G, Baldessarini R. Mania associated with antidepressant treatment: comprehensive meta-analytic review. Suicide deaths are 10 to 30 times more common among people with bipolar disorder than the general population, according to research published in July 2021 in Translational Psychiatry. A 2018 review of bipolar depression notes that antidepressant-induced affective switching appears more common among people who: You may be more likely to experience antidepressant-induced mania if you: Women, younger people, and those with a family history of bipolar disorder, may have an increased chance of antidepressant-induced hypomania, according to a 2020 unipolar depression review. Thats why some people say that antidepressants can make bipolar disorder worse. She was started on antidepressants, which triggered another manic episode. Racing thoughts or quickly changing ideas. A systematic review. 2010;121:40414. Camacho M, Almeida S, Moura AR, et al. Hypomania typically lasts for at least four days. saying or doing things that are inappropriate and out of character. Antidepressant-induced hypomania/mania in patients with major depression: Evidence from the BRIDGE-II-MIX study. While not everyone who experiences hypomanic symptoms has a mood disorder, their presence is important to any broader consideration of a persons mental health history. Chun B, Dunner DL. Trigger #6: Goal Attainment and Positive Events. 7. doi:10.1016/j.jad.2013.10.024, 4. Saving You Time. Clin Pharmacol Ther 1972;13:694-8. 13. Regardless, if you really do need to get hypomanic, act like you are. Thanks for visiting Psychiatry Advisor. Conflict with loved ones. Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Some people don't become hypomanic per se, but do become agitated, nervous, keyed up, and have trouble sleeping. Symptoms of hypomania improved as escitalopram was tapered off. One-year outcomes of unipolar depression patients with manic or hypomanic switch during acute antidepressant treatment. In anotherstudy published in the Journal of Affective Disorders, people with bipolar disorder said negative social experiences were among the events that triggered suicidal thinking for them. While hypomania can be a symptom of bipolar disorder, this state can occur for other reasons as well. Any moods related to elation, agitation, or grandiosity may be medication-induced or could mean you also have bipolar disorder. Depression can be part of bipolar disorder, but it can also exist on its own and co-occur with hypomania. Among those symptoms are a spike in self-esteem or grandiosity, a lowered inclination to sleep, greater talkativeness, and increased engagement in potentially hazardous activities such as excessive spending or risky sexual behavior. These mood episodes are usually shorter in duration and less severe than mania. Steroid-induced symptoms emerge from 3 to 4 days to a median of 11 days after a patient starts corticosteroid therapy. There are many case reports on LEV-induced psychosis, but there are only three case reports of mania induced by LEV use. J Affect Disord 2004;83:277-81. Rundell JR, Wise MG. Schimmer B, Parker K. Adenohypophyseal hormones and their hypothalamic releasing factors. As the discourse on mental illness in . Corticosteroid-induced adverse psychiatric effects: incidence, diagnosis and management. Treatment of depression with fluoxetine in corticosteroid-dependent central nervous system Sjogrens syndrome. One of lifes most unpredictable stressors? Daniel B. Neurosci Biobehav Rev. Do you have a hard time getting any sleep at all? Psychiatry Advisor. Some of the potential causes of hypomania include the following. Like medication, herbal supplements are not without their risks, and some have been linked with psychiatric symptoms. Bipolar disorder: assessment and management: NICE Guideline [CG185]. 2019;7(1):e5. The episodes are brief and usually resolves within 48 hours. found that of patients with MDD treated with antidepressants, 5.97% developed mania/hypomania. Arch Acad Emerg Med. While manic episodes typically last a week or longer and can have severe impacts on other areas of a person's life, hypomanic episodes are a bit shorter in duration (four or more days) and often not severe enough to impact work, school, or social functioning. 2013;17:21922. Narrow WE, Rae DS, Robins LN, Regier DA. increased . Hypomania. JAMA 1979;241:1011-2. Don't skip meals - force yourself to eat good food. What happens sometimes is, when I realize I'm about to crash and I'm really scared to, I stay up as late as I can, get a couple hours of sleep, and start drinking lots of caffeine. This is why I make sure I get lots of sleep.I don't like hypomania. The loss of a job or relationship. Ramic E, et al. It's a high that's addictive, and, like all addictions, it's dangerous and unhealthy. The new "energized you" is recognized by others as beyond your usual self. reduce the risk of a mood episode in patients who require sustained corticosteroid therapy. It may be a good idea to try to put away three to six months' worth of savings to help with the transition in case you lose your job. Listen Now! Characteristic behaviors of people experiencing hypomania are a notable decrease in the need for sleep, an overall increase in energy, unusual behaviors and actions, and a markedly distinctive increase in talkativeness and confidence, commonly exhibited with a flight of creative ideas. ECT was not restarted since it appeared to induce mania. There may be a blurry line between a functional period of hypomanic productivity and a more severe state that indicates professional care is warranted. Antidepressants in Bipolar Depression: An Enduring Controversy. All rights reserved. Any type of relationship conflict whether its with your partner, coworker, family member, or friend can trigger stress and send you over the edge. You may go. Barbuti M, et al. Our website services, content, and products are for informational purposes only. Am J Emerg Med 1999;17:735.-. An International Society of Bipolar Disorders task force report: Precursors and prodromes of bipolar disorder. Dis Nerv Syst 1976;37:663-7. Mania is a heightened mood state that causes hyperactivity and a decreased need for sleep. sleeping very little or not at all. The prospective link between cannabis use at age 17 and hypomania at age 22-23 years was tested using regression analysis, adjusted for gender, early environmental risk factors, alcohol and drug use, and depression and psychotic symptoms at age 18 years. Mood changes during prednisone bursts in outpatients with asthma. 2013;9:639-658. doi:10.2147/NDT.S43419, Faedda GL, Baldessarini RJ, Marangoni C, et al. And the part of your brain that worries about consequences turns a blind eye to your hypomanic adventures. Tondo L, Vazquez G, Baldessarini R. Mania associated with antidepressant treatment: comprehensive meta-analytic review. Cyclothymia is a perpetual see-saw of scattered moods wearing away at 1% of the population, but do you know this bipolar-spectrum illness when you see it? episode. It is a single isomer of the parent compound, citalopram. I just started 20mg of celexa and after several hours I started feeling hypomanic or hyper as people would say. Trigger #1: Sleep. . doi:10.1016/j.jad.2017.05.035, 15. A look at symptoms provides the key to correct diagnosis. Bipolar patients with a strong genetic loading for bipolar illness whose initial illness begins in adolescence or young adulthood may be especially at risk. Shift workers, people who work long and variable hours, and students who are short on sleep are all at risk for a recurrent mood episode related to a lack of sleep. In this report, we present a case with no history of psychiatric disorder who had a hypomania episode after receiving LEV for epilepsy treatment. 2017;219:18792, 14. 1 The authors define AAH as "hypomania occurring shortly after. If you live with bipolar disorder, you can also experience antidepressant-induced mania outside of your cyclic mood cycles. Bipolar disorder often presents initially with one or more episodes of major depression, and an episode of mania or hypomania may first occur during treatment with an antidepressant, stimulant, or other agent with mood-elevating effects. Saklad SR. Management of corticosteroid-induced psychosis with lithium. Can love trigger hypomania? Symptoms, Causes, Diagnosis, and Treatment, Bipolar Disorder: 8 Relationship Tips for Married Couples. Michael A. Cerullo, MDClinical assistant professor of psychiatry, Division of bipolar disorders research, University of Cincinnati College of Medicine, Cincinnati, OHDisclosuresThe author reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products. Bipolar disorder is characterized by unusual shifts in mood and energy. Do antidepressants increase the risk of mania and bipolar disorder in people with depression? While taking antidepressants, the. Gill N, Bayes A, Parker G. A Review of Antidepressant-Associated Hypomania in Those Diagnosed with Unipolar Depression-Risk Factors, Conceptual Models, and Management. Wada K, Sasaki T, Jitsuiki H, Takaishi Y. Feeling more talkative than usual or feeling a pressure to keep talking. Benazzi F, Akiskal HS. This chemical balance is even more delicate for individuals with bipolar disorder. Hypersexuality can lead to ruined relationships and sexually transmitted infections (STIs), for instance. By Marcia Purse Inside Bipolar Podcast: Managing Marriage and Bipolar. J Affect Disord. Wrong road to go down, trust me! SSRIs-induced hypomania/mania is estimated to be around 3%-6% in bipolar depression and less than 3% in major depressive disorder. What should you do about bipolar depression? I'm miserable when depressed and contemplate neg. To be transparent, not all impacts are negative. Hosang G, Martin J, Karlsson R, et al. 22. Cureus. People who werent satisfied with their work may find it liberating. Intoxication with drugs such as cocaine and amphetamines can cause or worsen manic symptoms, while the aftereffects of cocaine or alcohol use are associated with worsening depressive symptoms. London, NICE; 2016. https://www.nice.org.uk/guidance/cg185. 10. a decreased need for sleep. (2018). I think it's very important to experiment and discover what can affect you. For manic and hypomanic episodes, participants indicated the most common triggers were falling in love, recreational stimulant use, and starting a new creative project. Experiencing symptoms associated with hypomania and depression without mania suggests bipolar II disorder. Learn more. Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. The difficulty comes when I engage in self-destructive actions with little or no regard for the consequences. Hypomania . Bipolar 2 is mistakenly thought of as a "less serious" bipolar disorder, but nothing could be less true. Mania is scary, and it can be fatal. 3. Arch Gen Psychiatry 2002;59:115-23. How Psychologically Conditioned Rats Are Defusing Landmines, The Innate Intelligence Observed in the Dying Process. Mild form of mania. Neuropsychiatr Dis Treat. What is bipolar disorder?. Can J Psychiatry 2001;46:455-6. 4.2k. . Bipolar Disorder vs. BPD: What Are the Differences? Mania is a severe episode that may last for a week or more. Financial strain. Thank you, {{form.email}}, for signing up. Enjoying our content? Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: A review. It's pure bliss. Treatment at Bridges to Recovery. 7 Triggers That Can Lead to a Bipolar Episode, The 3 Types of Bipolar Disorder: Bipolar I, Bipolar II, and Cyclothymia, The 7 Most Effective Ways to Manage Bipolar 1 Disorder, Answers to Your Top 10 Questions About Atopic Dermatitis, 6 Strategies for Self-Care When You Have Bipolar 1 Disorder, Biggest Challenges of Bipolar 1 Disorder Manic Episodes (and How to Manage Them), 5 Complementary and Integrative Therapies That Might Help Bipolar Disorder and 4 to Approach With Caution, 7 Vitamins and Supplements That May Be Helpful for Bipolar Disorder, A Therapist Speaks: 5 Common Bipolar Medication Frustrations and How to Safely Manage Them, What Is Psychosis? Brown ES, Chamberlain W, Dhanani N, et al. The development of manic symptoms with LEV therapy is unusual. - Drug Monographs Currently working on my upcoming signature. In some cases, antidepressants are also used in the management of chronic pain, anxiety, and chronic insomnia. Please login or register first to view this content. It is often not easy to get a correct diagnosis when you have bipolar disease, but here are ways you can help your doctor. Citalopram comprises of R-citalopram and S-citalopram which are mirror images of each other. Escitalopram is one, which is a medication often used to treat both depression and generalized anxiety disorder. The literature reports vary as to the incidence of ECT-induced mania or hypomania.3,6 One study of 32 depressed subjects recorded a 12.5-percent switch to hypomania following ECT. Antidepressant-associated mania in bipolar disorder: A review and meta-analysis of potential clinical and genetic risk factors. Dumlu K, Orhon Z, zerdem A, Tural U, Ula H, Tunca Z. Treatment-induced manic switch in the course of unipolar depression can predict bipolarity: Cluster analysis based evidence. Copyright 2023 Haymarket Media, Inc. All Rights Reserved. (2020). Diagnostic symptoms. Select one: a. manic episode; hypomanic episode. If I'm unstable already, I can sometimes get hypomanic by waking up really early and going for a run, then, or by forcing psychomotor agitation and reciting a phrase in my head again and again. Not recommended though - stay safe out there!! 2022;79(2):143-150. doi:10.1001/jamapsychiatry.2021.3654, Rahmati F, Safari S, Hashemi B, Baratloo A, Khosravi Rad R. Prevalence of depression and personality disorders in the beginning and end of emergency medicine residency program; a prospective cross sectional study. Mania is not a formal symptom of depression, a condition defined as persistent low mood and inability to experience joy. Years later, Goodfellow revisits her account of the antidepressant-induced hypomania that hijacked her Costa Rican vacation and tells the rest of the story: her missed diagnosis of Bipolar 2, how she'd been given the wrong . Data were used from the Avon Longitudinal Study of Parents and Children, a UK birth cohort study. on August 6, 2021 in Psychiatry, a History. The 2 Most Psychologically Incisive Films of 2022, The Surprising Role of Empathy in Traumatic Bonding. 2023 Dotdash Media, Inc. All rights reserved. J Clin Psychopharmacol 2002;22:55-61. Which antidepressants are more likely to cause mania? Although, more research is needed to confirm whether sleep issues cause hypomania or if hypomania causes sleep issues. Its symptoms can disrupt daily functioning in some instances, though this disruption is typically mild. A key distinction when identifying if hypomania has gotten out of control is whether those around the person feel comfortable and safe. About 20 percent of people with bipolar disorder experience fluctuations in mood when the weather changes. Addressing Nutritional Deficiencies in Children with ADHD. Bipolar hypomania is considered present when a person experiences at least three of the following symptoms accompanied by a persistently elevated mood or four of these symptoms in association with a sustained irritable mood: Hypomania and bipolar disorder are diagnosed separately, so receiving a diagnosis of hypomania does not necessarily mean also being diagnosed with bipolar disorder and vice versa. Table 2 list of antidepressants and their categorizations. In: Hardman J, Limbird L, Gilman A (eds). Barbuti M, Pacchiarotti I, Vieta E, Azorin JM, Angst J, Bowden CL, et al. When I crash, I usually sleep a lot more, but often enough I'll get insomnia with that, too, and that can shoot me right back up. Anthony D. Smith LMHC on November 11, 2021 in Up and Running. In the meantime, here are a few tips to help you cope with symptoms of hypomania: If you or a loved one are struggling with hypomania, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat 1-800-662-4357 for information on support and treatment facilities in your area. While antidepressants are primarily prescribed for the treatment of major depressive disorder (unipolar or clinical depression), they may also be used to treat conditions featuring depressive episodes, like bipolar disorder. [deleted] 5 yr. ago. Dr. Tracey Marks discusses why it's important to address hypomania, even though this high energy phase of bipolar disorder is so seductive. Experts chalk this up to sunlight: Your circadian rhythm, the bodys internal response to changes in a 24-hour day, is affected by the amount of sunlight you get each day. 17-A hypomanic episode can include or lead to: Select one: a. psychotic symptoms. 19. Other forms of therapy, including psychoeducation and cognitive behavioral therapy (CBT), can also be helpful in managing the condition. Perhaps not. Causes of organic mood disorder. Episodes of cyclothymia tend to be shorter but are present for at least two years. Psychology Today 2023 Sussex Publishers, LLC. Francis M. Mondimore M.D. Front Psychiatr. It's really pretty exhausting and awful, and eventually I get a sort of emotional hangover. Beyond her desire to contribute to people's health and wellbeing through her writing, Batya offers emotional/spiritual support to clients in her Teaneck, New Jersey-based counseling practice to facilitate their journeys toward healing. Hypomania becomes a problem, however, if risky behaviors emerge or if the episode progresses into mania or depression. The information provided is for educational purposes only. Should we tell children that a family member has bipolar disorder? Hypomania describes a high that is less severe than a manic episode and without any delusions and/or hallucinations. During hypomania, people sometimes have an urge to act on behaviors that may be less helpful for them in the long run. The Boston Collaborative Drug Surveillance Program. Gen Hosp Psychiatry 2003;25:27-33. Pauley J. Skywriting: a life out of the blue. Gitlin MJ. In addition, most treatment trials of antidepressants for depression do not systematically assess patients for hypomanic symptoms during the . Pies R. Persistent bipolar illness after steroid administration. 2018;14:2099-2104. doi:10.2147/NDT.S168078, Kazi S, Karia R, Leontieva L. Herbal supplements: Can they cause hypomania?. While causes of stress are highly individual, certain life events and lifestyle patterns such as sleep or relationship issues may act as triggers. It often masquerades as joy, ambition, productivity and passion. Naber D, Sand P, Heigl B. Psychopathological and neuropsychological effects of 8-days corticosteroid treatment. 7 Changes in Sleep Patterns 2018;7(3):471-487. doi:10.1177/2167702618812725. Mania is a mood episode that presents with symptoms like agitation, elevated mood, and impulsivity. If you wish to read unlimited content, please log in or register below. And then I don't call my doc until I've done some damage, lost insight and gone completely manic for a couple of days and come back or just become really racey and aggravated and can't sleep at all. Some antidepressants. For someone experiencing a stretch of hypomania, a burst of energy, rush of ideas, or interest in achieving goals may add up to a generally positive experience. 14. 1996-2023 Everyday Health, Inc., a Ziff Davis company. 2012;148:12935. Elevated self-esteem, high self-confidence, or feelings of grandiosity. Antidepressant-induced hypomania/mania in patients with major depression: evidence from the BRIDGE-II-MIX study. 2018;89:119-131. doi:10.1016/j.neubiorev.2018.02.008, Stanton K, Khoo S, Watson D, Gruber J, Zimmerman M, Weinstock L. Unique and transdiagnostic symptoms of hypomania/mania and unipolar depression. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. A new review examines AAH in people diagnosed with unipolar depression, examining risk factors, conceptual models, and management. Here are ways to take care of yourself during the holidays if you have bipolar, Insomnia Tied to Dramatic Rise in Heart Attack Risk, Just 500 Extra Steps a Day Can Lower Heart Disease Risk in Seniors, Study Suggests. Whats more, with recurrent episodes, some people with bipolar disorder may experience less complete periods of remission and a greater likelihood of relapse, either to depression or mania, Dr. Bennett says. I was suddenly the equal of my high-energy friends who move fast and talk fast and loud. In cases of hypomania, your daily functioning isn't significantly impacted. Treatments include psychotherapy, medication and self-care . Terao T, Mizuki T, Ohji T, Abe K. Antidepressant effect of lithium in patients with systemic lupus erythematosus and cerebral infarction, treated with corticosteroid. Some experts argue that experiencing antidepressant-induced mania cant be properly classified under current diagnostic criteria for depression or bipolar disorder and should have its own subtype category in the list of diagnoses. While the episode may feel good while it's occurring, both conditions. Get the help you need from a therapist near youa FREE service from Psychology Today. And chocolate and black tea or coffee. A review of antidepressant-associated hypomania in those diagnosed with unipolar depressionrisk factors, conceptual models, and management. New York: Random House; 2004. Patel R, et al. Currently, researchers are considering including a bipolar or depressive disorder subtype that may be specific to antidepressant sensitivity causing a manic episode. Hypomania (literally, below mania) is a mood state characterized by persistent and pervasive elated or irritable mood, and thoughts and behaviors that are consistent with such a mood state. 18. - And More, Close more info about Antidepressant-Associated Hypomania: Navigating Clinical Challenges, Schizophrenia Spectrum and Psychotic Disorders, A Review of Antidepressant-Associated Hypomania in Those Diagnosed with Unipolar Depression-Risk Factors, Conceptual Models, and Management, Antidepressants in Bipolar Depression: An Enduring Controversy, Treatment and outcome of antidepressant treatment associated hypomania in unipolar major depression: a 3-year follow-up study, Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: A review, Mania associated with antidepressant treatment: comprehensive meta-analytic review, Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of Bipolar Disorders, Earlier onset of bipolar disorder in children by antidepressants or stimulants?

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