Antidepressant Associated Chronic Irritable Dysphoria in Bipolar Disorder: a Clinical Case

Abstract

Introduction The chronic dysphoric irritable state is a common consequence, but not very known, of the long-term antidepressants prescription for bipolar patients. The purpose of our study was to illustrate this clinical entity, through the study of a clinical case. Case study Our study focused on the case of Mrs LA, 36 years old and with a history of a major depressive episode treated with tricyclic antidepressant. The evolution when taking antidepressant, was marked by a persistent irritability, dysphoric mood and sleep disorders. These symptoms have been attributed to a personality disorder after eliminating organic causes. Increasing antidepressant doses induced to an exacerbation of the characterological symptomatology. A mood stabilizer was added in combination with low doses of antidepressants, but without finding premorbid functioning. After stopping a treatment of five months, Mrs. LA, showed an acute manic episode requiring hospitalization. Thus the diagnosis was of bipolar disorder type I. The long-term evolution when taking mood stabilizer alone was marked by the disappearance of characterological disorder and return to premorbid functioning. Conclusion Taking antidepressants in the case of bipolar individuals may induce a turning to mania, mixed episodes, rapid cycling or a the chronic dysphoric irritable state, recently described in the literature.