Antidepressant-associated mania in a patient with social anxiety disorder

Background

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).

Material and Methods

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

Results

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.

Discussion

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.