A Review of Antidepressant-Associated Hypomania in Those Diagnosed with Unipolar Depression-Risk Factors, Conceptual Models, and Management

Curr Psychiatry Rep. 2020 Mar 26;22(4):20. doi: 10.1007/s11920-020-01143-6.


Purpose of review: The nosology and management of antidepressant-associated hypomania (AAH) in the treatment of unipolar depression requires clarification. We sought to review recent studies examining AAH, focusing on risk factors, differing explanatory models, and management strategies.

Recent findings: AAH occurs more frequently in those of female gender, younger age, and with a bipolar disorder (BP) family history. Depressive features (e.g., suicidal ideation, psychotic symptoms) in those with AAH were similar to those with established BPs. Explanatory models for AAH describe it as (i) a transient iatrogenic event, (ii) a specific "bipolar III" disorder, (iii) indicative of "conversion" to BP, (iv) acceleration of BP, and (v) coincidental and unrelated to antidepressant medication. Management recommendations include antidepressant cessation, atypical antipsychotic medications, or switching to a mood stabilizer. Determinants and management of AAH in the treatment of unipolar depression requires considerable clarification, likely to be achieved by close clinical review and refined research studies.

Keywords: Antidepressant; Bipolar disorder; Hypomania; Management; Nosology; Risk factors.

Publication types

  • Review

MeSH terms

  • Antidepressive Agents / adverse effects*
  • Antidepressive Agents / therapeutic use
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / psychology*
  • Depressive Disorder, Major / drug therapy*
  • Humans
  • Risk Factors


  • Antidepressive Agents