A 45-year-old woman has recurrent depression treated with sertraline. She develops hypomanic episodes 5 days after starting sertraline. This pattern suggests the underlying diagnosis should be revised to:
- A Major depressive disorder with anxious distress
- B Cyclothymic disorder
- C Bipolar II disorder (or bipolar spectrum) ✓
- D Borderline personality disorder with mood instability
Explanation
Antidepressant-induced hypomania or mania is a diagnostically and therapeutically important finding. DSM-5 states that if a full hypomanic or manic episode emerges during antidepressant treatment (pharmacologically or ECT-induced) and persists beyond the physiological effect of that treatment, it counts toward a diagnosis of bipolar I or II disorder. Unrecognised bipolar spectrum disorder is a common reason for inadequate antidepressant response and cycling. This presentation should prompt transition to a mood stabiliser (lithium, lamotrigine, valproate) rather than escalating antidepressant therapy.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.