Which signs in a depressed patient could indicate a manic transformation? All depressive states can give way to a state of manic excitation. The transformation can be spontaneous or favoured by antidepressants. The principal indices of risk of mood transformation are a personal or family history of mood disorders, thymic lability, marked psychomotor inhibition, the existence of overeating and hypersomnia, early age of onset, acute onset and resolution of episodes. It is important in the presence of these elements to re-evaluate the indication for an antidepressant and to consider the prescription of a mood stabiliser as monotherapy or in association with an antidepressant.