Had a patient come to me with a history of what sounded like a manic episode (with no prior history of mania), while taking double the maximum recommended dose of escitalopram. I concluded the high dose of the SSRI must have been responsible. The patient's mood has since stabilized with aripiprazole, but eventually I'd like to taper off this medication if possible to minimize side effect risk. The patient also has a lot of anxiety symptoms, which I'd like to treat with an SSRI...
Since I haven't encountered this kind of situation before, I'm wondering what the general guidelines are for management of medication-induced bipolar disorder. Would this have to be treated like bipolar I disorder, or could this patient possibly do well with an unopposed SSRI prescribed at an appropriate dose? Also, assuming the patient's mood remains stable, how long should the diagnosis be retained? Is this something that can be considered resolved at some point?
Since I haven't encountered this kind of situation before, I'm wondering what the general guidelines are for management of medication-induced bipolar disorder. Would this have to be treated like bipolar I disorder, or could this patient possibly do well with an unopposed SSRI prescribed at an appropriate dose? Also, assuming the patient's mood remains stable, how long should the diagnosis be retained? Is this something that can be considered resolved at some point?