Rare and very rare, but potentially serious adverse effects
Temporary elevation in mood may occur because the patient feels better again. However, this needs to be distinguished from a sustained disproportionate and inappropriate elevation in mood, which may signify a manic episode.
Factors which increase risk
In undiagnosed bipolar disorder the stimulating effect of SSRIs possibly exposes the bipolar vulnerability. In rare cases, psychotic reactions to SSRIs have occurred.
Risk-reduction measures
When considering a patient for an SSRI, a good medical history should be taken, particularly questioning the patient about: any previous episodes of mania or mania-like features; previous diagnosis of bipolar disorder; and family history of bipolar disorder, other psychotic disorders or manic reactions in response to SSRIs. Those with a history suggestive of bipolar disorder require treatment under specialist guidance.
Treatment
Occurrence of manic or psychotic symptoms should lead to discontinuation of SSRI treatment and urgent specialist review.
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