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Antidepressant-associated mania in a patient with social anxiety disorder


The relation between anxiety and bipolar disorders has recently drawn much interest, as a growing number of studies report higher than expected comorbidity rates of bipolar (especially bipolar II) disorder with panic disorder (PD), obsessive compulsive disorder (OCD) and social anxiety disorder (SP).

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We present a case of antidepressant-associated mania in a patient with social anxiety disorder.


The patient received treatment with paroxetine, upon which his anxiety symptoms improved greatly; however, two months after the initiation of treatment, the patient developed a manic episode with elevated mood, increased self-esteem, hyperactivity, increased sexual activity and reckless behaviour, resulting in the patient being dismissed from his job and creating large debts. All these symptoms gradually subsided after the discontinuation of paroxetine; unfortunately, this lead to the re-emergence of anxiety symptoms, this time complicated by depression.


In this context, cases of antidepressant-induced mania occurring in patients with anxiety disorders are of great interest, since they could be interpreted as evidence for a connection between the two disorder spectrums. So far, such cases have been described in PD and OCD patients; one additional study reports the frequent development of hypomania in SP patients successfully treated with monoamine oxidase inhibitors.

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Andreou, C., Tsipropoulou, V., Bozikas, V. et al. Antidepressant-associated mania in a patient with social anxiety disorder. Ann Gen Hosp Psychiatry 2 (Suppl 1), S145 (2003).

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