Possible Antidepressant-Associated Activation of Mania and Psychosis in the Mentally Retarded: Four Case Reports

Letter to the Editor

Sir: In some individuals, antidepressants can activate manic and psychotic behavior. Individuals with a history of mania and psychosis are uniquely vulnerable to this behavior. When the use of antidepressants in the mentally retarded is considered, evidence of a major Axis I disorder may be difficult to determine. In the literature on use of antidepressants in the mentally retarded, there are a number of reports of pathologic behavioral activation suggesting underlying manic or psychotic disorders that were not initially apparent. We report here 4 consecutive cases over a 4-month period that demonstrate worsening manic or psychotic behavior associated with antidepressant use in mentally retarded individuals. In 3 of 4 instances, there was a previous history of manic or psychotic behavior. Therefore, in the mentally retarded, as in the rest of the adult population, care should be taken in the use of antidepressants in individuals with a possible history of mania or psychosis.