Mastering psychiatry is crucial for success in the PLAB 1 or UKMLA exams. Today, we'll dive into a high-yield question on antidepressant-induced mania – a topic that frequently appears on these exams. MedRevisions is committed to helping you ace your exams with in-depth explanations and top-notch study materials. Let's get started!

UKMLA or PLAB 1 exam style Question:

A 60-year-old man has been sleeping only a few hours per night for the past 2 weeks. He reports feeling excessively energetic and engaging in multiple projects, with a decreased need for sleep. He was diagnosed with depression and began antidepressant medication 3 months ago. What is the most appropriate next step in his management?

A. Increase his antidepressant dose

B. Start lithium

C. Start olanzapine

D. Stop his antidepressant

E. Switch to a different antidepressant

Answer is given below

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Answer and Detailed Explanation:

Correct Answer: D. Stop his antidepressant

Clinical Scenario: The patient's symptoms of decreased sleep, hyperactivity, and increased energy strongly suggest a manic or hypomanic episode. This is especially concerning given his recent initiation of antidepressant treatment for depression.

Differential Diagnosis: The most likely diagnosis is antidepressant-induced mania. This occurs when a patient with underlying bipolar disorder (which may have been undiagnosed) experiences a manic or hypomanic switch after starting an antidepressant.

Management of Antidepressant-Induced Mania: The immediate and most appropriate step is to stop the antidepressant. Continuing it could worsen the manic symptoms.

Why Other Options Are Less Appropriate:

A. Increase his antidepressant dose: This would likely exacerbate the mania and is contraindicated.
B. Start lithium: Lithium is a mood stabilizer used for bipolar disorder, but the priority is to stop the antidepressant first. Lithium may be considered later for long-term management.
C. Start olanzapine: Olanzapine is an antipsychotic that can manage acute mania, but stopping the antidepressant is the essential initial step. Olanzapine might be added if mania persists after antidepressant discontinuation.
E. Switch to a different antidepressant: Switching would not address the underlying issue and could potentially worsen the mania.

Long-Term Management:

After stopping the antidepressant, the patient should be closely monitored. If manic symptoms continue, a mood stabilizer (e.g., lithium) or an antipsychotic (e.g., olanzapine) might be initiated to manage the current episode and prevent future ones.

PLAB / UKMLA High-Yield Exam Tips:

Antidepressant-induced mania is a classic presentation of undiagnosed bipolar disorder.
Always consider the possibility of bipolar disorder in patients with new-onset mania, especially if they have a history of depression or are taking antidepressants.
The immediate management of antidepressant-induced mania is to discontinue the antidepressant.

Sign up for FREE 20 Sample PLAB 1/MLA Questions with complete notes

References

- National Institute for Health and Care Excellence (NICE). Bipolar disorder: assessment and management. [NICE Guideline](https://www.nice.org.uk/guidance/cg185).

- Patient.info. Bipolar Disorder. [Patient Info](https://patient.info/doctor/bipolar-disorder).

- Medscape. Bipolar Disorder. [Medscape Article](https://emedicine.medscape.com/article/286342-overview).

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