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Cited by 28Bipolar Disorder and TreatmentTreatment of Major DepressionSleep and related disorders

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Low Risk for Switch to Mania during Treatment with Sleep Promoting Antidepressants

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Wichniak, A., Jarkiewicz, M., Okruszek, Ł., Wierzbicka, A., Holka-Pokorska, J., Rybakowski, J.·2015·Pharmacopsychiatry
DOI 10.1055/s-0034-1396802
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Abstract

INTRODUCTION: Sleep-promoting antidepressants are of interest because they are used not only as antidepressants, but also to promote sleep. METHODS: We reviewed case reports describing the switch to mania during treatment with trazodone, mirtazapine, or agomelatine. RESULTS: Trazodone, mirtazapine, and agomelatine may induce manic symptoms. However, the risk of switching is related, first of all, to doses recommended for antidepressant treatment, administered without mood-stabilizer co-therapy. Low doses of these antidepressants, used for their hypnotic or sedative effects, were observed to cause mania only in patients with other risk factors for switching. There is no evidence for trazodone or mirtazapine and only sparse evidence for agomelatine, claiming that treatment with these antidepressants is related to an increased risk of switching to mania when administered in combination with a mood stabilizer. DISCUSSION: These findings suggest that low doses of trazodone and mirtazapine are safe in bipolar disorder, and should still be considered important alternatives to hypnotics when long-term pharmacological treatment of insomnia is necessary. It seems that these antidepressants and agomelatine can also be used safely in antidepressant doses when combined with a mood stabilizer.

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Crossref · 10.1055/s-0034-1396802

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  • Based on clinical experience and review of published case reports, the use of sedative antidepressants in a low dose is not related to increased risk of phase shift in bipolar disorder.

    “Based on our clinical experience and review of published case reports, we believe that the use of sedative antidepressants in a low dose is not related to the increased risk of phase shift in bipolar disorder [45].”

    From Effects of Antidepressants on Sleep (2017) · cites this paper as [45]

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Research works printed but not linked: 40

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Metadata

Authors
Wichniak, A., Jarkiewicz, M., Okruszek, Ł., Wierzbicka, A., Holka-Pokorska, J., & Rybakowski, J.
Affiliations
  • Institute of Psychiatry and Neurology (PL)
  • University of Warsaw (PL)
  • Poznan University of Medical Sciences (PL)
ORCID
Venue
Pharmacopsychiatry
Publisher
Georg Thieme Verlag KG
Published
2015-01-19
Volume
48
Issue
03
Pages
83-88
ISSN
  • 0176-3679 (ISSN-L)
  • 1439-0795
DOI
10.1055/s-0034-1396802
OpenAlex
W1995707150
Cited by
28
References
7
Citations by year
2026: 1 · 2025: 5 · 2024: 7 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 1 · 2017: 4 · 2016: 2
FWCI
0.30
Type
journal article
Language
en
Open access
Locations
  • Pharmacopsychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
bipolar disorder, trazodone, mirtazapine, agomelatine, antidepressant-induced mania, hypnotic effects, insomnia treatment, dose-dependent risk
MeSH terms
Antidepressive Agents, Bipolar Disorder, Depression, Drug Therapy, Combination, Humans, Sleep, PubMed

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