Can Lexapro trigger mania? Understanding the Risks for Bipolar Disorder

According to the FDA, Lexapro (escitalopram) or other antidepressants may precipitate a mixed or manic episode in patients with bipolar disorder. This highlights a crucial risk for individuals with pre-existing or undiagnosed bipolar spectrum disorders when taking this common selective serotonin reuptake inhibitor (SSRI).

Quick Summary

Lexapro can activate a manic or hypomanic episode, especially for individuals with undiagnosed bipolar disorder. Careful screening and concurrent use of a mood stabilizer are essential to manage this risk.

Key Points

• Mania Risk is Real: Lexapro and other SSRIs can trigger manic or hypomanic episodes, particularly in individuals with undiagnosed bipolar disorder.

• Screening is Crucial: Prior to prescribing Lexapro, healthcare providers should screen patients for any personal or family history of bipolar disorder.

• Symptoms of Mania: Watch for symptoms like increased energy, decreased need for sleep, rapid speech, racing thoughts, and engaging in risky behaviors.

• Combination Therapy: For those with confirmed bipolar disorder, Lexapro should only be used in combination with a mood stabilizer to mitigate the risk of manic episodes.

• Immediate Action: If mania or hypomania is suspected, contact your doctor immediately, as the medication may need to be stopped and a mood stabilizer introduced.

• Dosage Matters: Case studies suggest a higher dose of escitalopram, the active ingredient in Lexapro, may increase the risk of triggering a manic switch.

How Antidepressants Like Lexapro Can Trigger Mania

Lexapro increases serotonin levels in the brain, a mechanism effective for depression and anxiety. However, for individuals with bipolar disorder, this increase can overstimulate mood regulation, potentially triggering a manic or hypomanic episode. This risk, known as 'antidepressant-induced mania' or 'affective switching,' is a recognized concern when SSRIs are used alone for depression, affecting those with diagnosed bipolar disorder and those with underlying, undiagnosed bipolar tendencies. Healthcare providers should thoroughly screen patients for personal or family history of bipolar disorder before prescribing Lexapro.

Recognizing the Symptoms of Medication-Induced Mania

Identifying mania or hypomania symptoms is vital for individuals taking Lexapro. These symptoms represent a notable change from typical behavior and require prompt attention.

Potential signs and symptoms include:

• Elevated or Irritable Mood
• Increased Energy and Activity
• Decreased Need for Sleep
• Racing Thoughts and Rapid Speech
• Grandiosity
• Reckless Behavior
• Distractibility

Some individuals may experience a mixed episode, with simultaneous symptoms of both mania and depression.

Managing Lexapro-Induced Mania

If mania or hypomania is suspected, seek immediate medical help. Management typically involves:

1. Discontinuing Lexapro: The antidepressant is usually stopped, potentially with a gradual taper.
2. Starting Anti-Manic Medication: A mood stabilizer or atypical antipsychotic is often prescribed.
3. Ensuring Safety: Measures to protect the individual from risky behaviors are paramount.
4. Developing a Long-Term Plan: After stabilization, a new medication strategy, often including a mood stabilizer, is established.

Lexapro vs. Mood Stabilizers: A Comparison

Feature	Lexapro (Escitalopram)	Mood Stabilizers (e.g., Lithium, Lamotrigine)
Primary Function	Treats depression and anxiety by increasing serotonin.	Manages bipolar mood swings.
Risk of Mania	Can trigger mania in individuals with bipolar disorder.	Designed to prevent mania.
Recommended Use in Bipolar	Use with caution and a mood stabilizer.	Standard treatment for bipolar disorder.
FDA Approval	Approved for depression and anxiety.	Approved for bipolar disorder.
Monitoring	Close monitoring for mania is essential.	May require regular blood tests.

Conclusion

Lexapro, while effective for depression and anxiety, carries a risk of triggering mania, particularly in those with undiagnosed bipolar disorder. Comprehensive screening before prescribing antidepressants is essential. For individuals with bipolar disorder, Lexapro is generally not recommended alone and should be used with a mood stabilizer if necessary. Recognizing mania symptoms is crucial for prompt action, which can involve stopping the medication and starting a mood stabilizer. Consult a doctor immediately if experiencing unusual mood or energy changes while on Lexapro.

For further information, refer to the official FDA label for Lexapro, which contains warnings about the potential for activating mania or hypomania.

Accessdata.fda.gov: Lexapro (escitalopram oxalate) Label

Frequently Asked Questions

Who is most at risk for Lexapro-induced mania?

Individuals with undiagnosed bipolar disorder are most at risk. Many people with bipolar disorder are initially misdiagnosed with major depressive disorder and prescribed antidepressants, which can then trigger a manic episode.

Can Lexapro cause mania in someone without bipolar disorder?

Yes, although less common, it is possible. Antidepressant-induced mania has been reported in patients treated for major depressive disorder who have no prior personal or family history of bipolar disorder.

How soon can mania appear after starting Lexapro?

The onset of mania or hypomania can vary. In some cases, it can occur within weeks of starting the medication or increasing the dosage, particularly if there is an underlying predisposition to bipolar disorder.

What is the difference between mania and hypomania?

Mania is a severe episode of elevated mood, energy, and activity that significantly impairs daily functioning. Hypomania is a milder form with less severe symptoms and shorter duration, but it can still lead to problematic behavior.

What should I do if I think Lexapro is making me manic?

You should contact your doctor immediately. Do not stop taking the medication abruptly without professional guidance, but do not ignore the symptoms. Your doctor will likely want to stop the antidepressant and may start a mood stabilizer.

Is it safe to take Lexapro with a mood stabilizer for bipolar depression?

Prescribing an antidepressant like Lexapro alongside a mood stabilizer is a common practice for treating bipolar depression. A mood stabilizer is intended to prevent the antidepressant from triggering a manic episode.

Does the dosage of Lexapro affect the risk of mania?

Case reports suggest that a dose increase can be a trigger. One study noted that manic or hypomanic symptoms emerged after the dosage was increased to 20 mg/day in certain patients.