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Atypical antipsychotic-induced mania: A systematic review and meta-analysis

Beatriz Côrte-Real1, Rodrigo Saraiva1, Catarina Rodrigues Cordeiro1

  • 1Department of Psychiatry and Mental Health, Centro Hospitalar Universitário Lisboa Norte, Av Prof. Egas Moniz, 1649-035 Lisboa, Portugal; Psychiatric and Medical Psychology University Clinic, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal.

Journal of Affective Disorders
|April 21, 2023
PubMed
Abstract

Insights

Atypical antipsychotics (AA) do not increase the risk of treatment-emergent mania (TEM). In fact, AA use was found to protect against TEM, suggesting mania induced by AA is rare.

Area of Science:

  • Psychiatry
  • Pharmacology

Background:

  • Atypical antipsychotics (AA) are associated with potential induction of manic symptoms.
  • This study aimed to investigate the association between AA exposure and mania in mood disorder patients.

Approach:

  • A systematic review and meta-analysis were conducted following PRISMA guidelines.
  • Searched for relevant studies published up to April 4th, 2022.
  • Meta-analysis compared the frequency of treatment-emergent mania (TEM) with AA versus placebo.

Key Points:

  • 52 studies were included, with 24 case reports detailing 40 manic/hypomanic episodes attributed to AA.
  • Meta-analysis of 21 placebo-controlled trials (4823 on AA, 3252 on placebo) revealed AA use protects against TEM (OR: 0.68).
  • Causality was difficult to establish in case reports, and TEM was inconsistently defined.

Conclusions:

  • AA exposure does not represent a significant risk for TEM; placebo was associated with higher TEM rates.
  • Mania/hypomania induced by AA appears to be rare, as anecdotal reports were not corroborated in larger studies.
Keywords:
Atypical antipsychoticBipolar disorderMajor depressive disorderManiaMood disorderTreatment

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