Mania Associated with Mirtazepine Treatment and Mixed Depression

Is antidepressant-associated mania always an evidence of a bipolar spectrum disorder? A case report and review of the literature

OBJECTIVE

The authors consider the clinical implications of characterizing every case of antidepressant-induced mania as evidence of an underlying bipolar diathesis.

METHOD

The authors report the case of a 45-year-old man, with no personal or family history of bipolar symptoms, who developed manic symptoms after sertraline initiation for a first lifetime depressive episode.

RESULTS

The patient's manic symptoms resolved rapidly with cessation of sertraline. His depressive symptoms responded to mirtazapine, and he had no further mood episodes during 2-year follow-up.

DISCUSSION

It may not always be appropriate to identify selective serotonin reuptake inhibitor-induced manic symptoms as pathognomonic for the bipolar diathesis, particularly as the bipolar formulation has distinct implications for future pharmacologic choices.

The psychiatric cultural formulation: translating medical anthropology into clinical practice

This article reviews proposed revisions to the DSM-IV Outline for Cultural Formulation for clinical practice. The author begins by exploring the theoretical development of and assumptions involved in the Cultural Formulation. A case presentation is then used to demonstrate shortcomings in the current implementation of the Cultural Formulation based on older definitions of culture. Finally, the author recommends practical questions based on the growing anthropological literature concerning the interpersonal elements of culture and the social course of illness. A simple clear format that clinically translates social science concepts has the potential to increase use of the Cultural Formulation by all psychiatrists, not just those specializing in cultural psychiatry.