Study Suggests Mania More Common in Psychosis When Antidepressants Used

A prospective cohort study of those labeled high risk for psychosis finds a higher prevalence of antidepressant use among those who develop manic symptoms


A recent study published in Schizophrenia Research examines longitudinal data in a cohort of patients identified as “Ultra-High Risk for psychosis.” The researchers found that participants were more likely to develop manic symptoms if they were previously prescribed antidepressants. The study was unable to clarify whether this increased risk was mediated by the presence of more severe depression symptoms at baseline.

The results of this study are especially interesting given the results of a previously reported study which found an association between the use of antidepressants and elevated risk for mania. Researchers out of King’s College found that of 21, 000 adults treated with depression, 994 were later diagnosed with mania or bipolar disorder.

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To fit criteria for being “Ultra-High Risk” for a psychotic disorder, participants had one or more of the following symptoms: attenuated psychotic symptoms, brief limited intermittent psychotic symptoms, and/or trait vulnerability for psychotic illness and deterioration in functioning or chronic low functioning. Clinical risk factors assessed at baseline included: subthreshold manic symptoms, depression, family history of bipolar disorder, schizophrenia and/or psychotic disorders, and depression among first or second-degree relatives, substance use, symptom severity, functioning, and medication use.

Participants were followed up between 5 and 13 years and reassessed using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I/P) or statewide registries were checked to see if the participant had contacted mental health services and received a diagnosis. Two subgroups were derived, those who went on to develop a manic episode and those who did not develop mania or a threshold psychosis.

Eighteen (4.3%) participants developed mania. The group that went on to develop mania also had a high rate of transition to psychosis (77%). Moreover, those who went on to develop mania had significantly higher prevalence of subthreshold manic symptoms at baseline and had a higher prevalence of having been prescribed antidepressants (76% vs 38%).

Those who later developed mania also had significantly lower functioning scores at baseline. There was no difference in the prevalence of cannabis use between the two groups. Small effects were found between the two groups regarding differences in global functioning and depression. There was a significant association between subthreshold manic symptoms and antidepressant use.

While the proportion of those who transitioned to mania was low, those that did had a greater baseline of subthreshold manic symptoms, antidepressant use, and lower functioning. The authors of this paper emphasize the higher subthreshold symptoms at baseline in those that later developed mania and the importance of a prodromal approach to treatment.

The authors do mention that the higher prevalence of antidepressant use may contribute to the development of mania and that greater severity of depression has been associated with developing mania.  However, they explain this by pointing out that those with more severe depressive symptoms are more likely to be prescribed antidepressants. While this may be the case, this study does not allow us to untangle the impact of depression severity from the use of antidepressants on developing mania.

It is of note that those who had higher subthreshold manic symptoms went on to develop mania, future research may explore whether a group with similar subthreshold symptoms develop mania at similar rates if they are not placed on antidepressants.



Ratheesh, A., Cotton, S. M., Davey, C. G., Lin, A., Wood, S., Yuen, H. P., … & Nelson, B. (2017). Pre-onset risk characteristics for mania among young people at clinical high risk for psychosis. Schizophrenia Research. (LINK)

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Bernalyn Ruiz
MIA Research News Team: Bernalyn Ruiz-Yu is a Postdoctoral Fellow in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles. She completed her Ph.D. in Counseling Psychology from the University of Massachusetts Boston. Dr. Ruiz-Yu has diverse clinical expertise working with individuals, families, children, and groups with a special focus on youth at risk for psychosis. Her research focuses on adolescent serious mental illness, psychosis, stigma, and the use of sport and physical activity in our mental health treatments.


    • Sure, it is true, the antidepressants can create symptoms that the “mental health professionals” label as “mania,” despite this being a blatant misdiagnosis according to the DSM-IV-TR itself.

      And by adding more antidepressants, and/ or adding the DSM “bipolar” drug cocktail recommended antipsychotics to “cure” the “mania;” the psychiatrists can create a “psychosis,” via what should be diagnosed as an anticholinergic toxidrome induced “psychosis.”

      But since anticholinergic toxidrome is not listed in the DSM, this type of psychiatric drug induced “psychosis” is always misdiagnosed as a “psychosis” caused by one of the scientifically invalid, but billable, DSM disorders.

      Thus resulting in future endless iatrogenic torture, as the psychiatrists, ad nausium, try to find “the right drug cocktail.” Psychiatry is one, gigantic, iatrogenic illness creation system.

      And the psychiatric industry’s primary actual function within our society today, according to their own medical literature, is covering up child abuse by turning millions of child abuse victims into the “mentally ill” with the psychiatric drugs.

      I’d like to see the “mental health professionals” get out of the business of profiteering off of aiding, abetting, and empowering pedophiles.

      One would think this MO of the “mental health industry” might become an embarrassment to those working within the “mental health” industries at some point. Especially since, of course, such maltreatment of child abuse victims, our society’s weakest members, is illegal, immoral, and repugnant.

      “A society will be judged based upon how it treats its weakest members.” Upside down and backwards, American “mental health professionals.”

      You were misled by those who financed your miseducation, the same globalist financiers who our founding fathers forewarned us about centuries ago, and “the corporations that will grow up around them,” like big Pharma.

      How long will it take for today’s “mental health” industries to wake up, overcome their delusional belief in their scientifically invalid DSM “bible,” and get out of the business of profiteering off of covering up child abuse en mass, while empowering the fiscally irresponsible, globalist, “luciferian,” “elite.”

      Oops, the “mental health professionals” neglected to do their most important job, cover up the child abuse sins of the globalists who create the money they worship out of thin air, un-Constitutionally charge our government un-godly interest on this made up paper money, and who will soon crash the world’s economy.

      Is it actually a good thing that the “mental health professionals” believe the ethical, fiscally responsible, American banking families – who helped make America great with our fiscally responsible lending practices and our belief in justly sharing the wealth with all – are all “irrelevant to reality,” “w/o work, content, and talent,” and have “credible fictional” lives?

      What if we’re actually “insightful,” as opposed to “fictional” people, who knew never ending wars inspired by 9/11/2001 would bankrupt our country, prior to the “mental health professionals” garnering insight into this reality, instead? Maybe, just maybe, concerns of child abuse and disgust at 9/11 isn’t actually a “lifelong, incurable, genetic mental illness”?

      Perhaps the concept of mutual respect, treating others as you’d like to be treated, is a wiser theology for a society than the theology found in the DSM stigmatization “bible?” And maybe, just maybe, the Federal Reserve Ponzi scheme of the war mongering, fiscally irresponsible, globalist banksters is not actually the best way to manage a monetary system, let alone how to manage the entire world’s monetary system?

      Pardon the “fictional” frustrations and rantings of one defamed and declared to have a “credible fictional” life by today’s child abuse profiteering, gas lighting “mental health” industry. Pray to God for justice for all.

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      • Ah…but that is the thing Someone Else. I do not discount your experiences or your pain. But when once repeats the same thing over and over again a million times, people only label them as cranks who cannot let go. From there comes the notion that they are “ill” or “nuts” or they “need help” etc. It defames the whole group.

        I know this, because like you, I have endured pain, and injustice, and terror and gaslighting, and in my moments of fury and rage, I say “the same thing over and over again” because there has never been any justice that has crossed my way.

        You have mentioned “Anticholinergic Toxidrome” enough times to last a lifetime. You have also mentioned “fad, fraud DSM, pharma” a hundred times.

        I only wish that you find some peace within yourself, and use your considerable intelligence to move away from that and onto something more constructive.

        BTW, I make no pretenses, because I am quite destroyed as well. It is, in some sense, like the pot calling the kettle black.

        But I hope you understand what I mean.

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          • @ registered

            No problem. I am just having one of those days because I saw and heard something on one of the units where I work and it sent me through the roof. Another example of staff damaging people without even realizing it and probably they don’t care if they do realize it.

            I’ve just learned to skip over certain things that some people post. I learned that I had more important things to become upset about in the long run. Overall, I learn so much from the people who come here to post. I can now hold my own in most discussions with clinical staff and a lot of that is due to what I’ve learned from you all here at MIA. It’s sort of like family here; you grow to ignore the aggravating traits that certain family members have and you love them because they are your family.

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        • Registered,

          I’m sorry you are annoyed by my repeatedly pointing out that the antipsychotics create psychosis, but the majority of the “mental health” professionals are still unaware of this fact, and I’d like to wake them up. And I speak in medical terminology, since that’s the only language that seems to get through to them.

          I don’t think I’ve ever spoken about a “fad” on this website, although I have mentioned the scientific invalidity of the DSM, since again, the reality of this problem has obviously not gotten into the skulls of the “mental health industry,” since they’re still utilizing the DSM.

          And just so that you know, it’s not so much what happened to me personally that disgusts me, it’s the psychiatric industries continuing attacks on the children of our country that appalls me. It’s also the fact that the “mental health” industry’s primary actual function within our society is turning child abuse victims into the “mentally ill” with the psychiatric drugs, that disgusts me so much. I want their illegal behavior, which results in their harm of innocent children, especially child abuse victims, to end.

          Thank you, Stephen.

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  1. Does anyone ever wonder where the term “psychosis” came from? If we took the time to study the history of psychiatry, we would begin to see that such psychiatric gobbledygook was tainted from the outset. But it’s a bit ridiculous to watch “science” try to catch up to the reality that psychotropic drugs cause the very “psychosis” that they are purported to cure. If it weren’t so tragic, it would be comedy.

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  2. These articles always make me smile, because they are meant to inflame.
    They are written under a pretence of looking for connections, and every other word lists a “disorder”.
    I think it must be hilarious to sit in the DSM room and hear them talk. I mean, how does one come up with “subthreshold manic symptoms”…..”transition to psychosis”.
    Like STD says. It would be comedy if not so tragic.
    I am actually now a bit grossed out by shrinks, not just angry, but grossed out. It is their dark minds, they make me shudder to think what lies behind such beliefs. I know more lies there than the words they speak… I know something resides in there, something very oppressed.
    And in some ways, I feel sorry for them.

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