Although rarely reported, the induction of
hypomanic/manic episodes due to sudden or gradual cessation of antidepressant
drugs is a phenomenon observed in clinical settings. Herein we present 2
patients that had manic episodes induced by gradual cessation of antidepressant
drugs. Common features of both cases were as follows: patients were female; a
major depressive episode was the reason for starting treatment; familial
loading for unipolar depressive disorder; venlafaxine was administered for
treatment of the episode; mood elevation symptoms while gradually decreasing
the medication dose; absence of physical symptoms related to withdrawal;
antipsychotic and mood stabilizing drugs were required for the treatment of the
episode. In both cases 1) a hypomanic/manic episode induced by the use of
antidepressants, 2) agitated depression, 3) physical withdrawal syndrome, and
4) spontaneous episodes in the natural course of the illness were the 4
different states that were taken into consideration for differential diagnosis.
Hypomanic/manic episodes induced by cessation of antidepressant drugs are
thought to shed light on the etiology of bipolar disorder, which this report
discusses with reference to the case reports.