Abstract
Hypomania and mania during antidepressant (AD) treatment in major depressive disorder (MDD) is a challenging situation that necessitates a re-evaluation of diagnosis and treatment management. The concept of antidepressant-induced hypomania and mania (AIHM) is not yet unified, and there is evidence for several alternative scenarios, ranging from AIHM as a manifestation of bipolar disorder (BD) to an iatrogenic, reversible effect of AD.
The current versions of mental disorder classification systems (Diagnostic and Statistical Manual of Mental Disorders, DSM-5; International Classification of Diseases, ICD-11) recommend that AIHM if a fully syndromic episode persists after the cessation of AD, should be considered a bipolar disorder (BD) type I or II, and management should follow the guidelines for this illness. However, research also supports the possibility of a more differentiated approach that includes an assessment of the severity and duration of AIHM, along with the presence of risk factors for conversion to bipolar disorder (family history of bipolar disorder, early onset of illness, previous unsatisfactory response to AD, psychotic or atypical symptoms, or psychiatric comorbidities), and the decision on maintenance treatment can be made depending on the individual degree of "bipolarity".
However, the lack of prospective follow-up of patients after AIHM does not yet allow definitive conclusions.