It has been considered that one of the mechanisms that cause mania is related to increased levels of serotonin (Shiah and Yatham, 2000).
Norepinephrine and serotonin have been consistently linked to psychiatric mood disorders such as depression and bipolar disorder.
Serotonin is a chemical that the body produces naturally. It's needed for the nerve cells and brain to function. But too much serotonin causes signs and symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can cause death if not treated.
Abstract. Objectives: Serotonin (5-hydroxytryptamine, 5-HT) was implicated in the pathophysiology of manic-depressive illness as early as 1958. Although extensive evidence has accumulated since then to support 5-HT's role in depression, relatively fewer studies examined its role in mania.
One is that there are low concentrations of intrasynaptic serotonin in patients with bipolar disorder, thus facilitating serotonin transporter internalization. Deficits in synaptic serotonin may be consequent to alterations in binding of other neurotransmitters.
In people with bipolar disorder, SSRIs and other antidepressants carry a risk of inducing mania, making it essential to monitor for signs of excess energy, decreased need for sleep, or abnormal and excessive mood elevation.
Pyridostigmine induced growth hormone release in mania: focus on the cholinergic/somatostatin system. Clin Endocrinol (Oxf). 1994 Jan;40(1):93-6. doi: 10.1111/j.
The consensus for these studies is that antidepressants with dual-action serotonergic-noradrenergic activity, such as tricyclics and venlafaxine, are more likely to induce hypomania or mania than serotonergic agents.
Conclusion: In the absence of risk factors for manic switch, sertraline-induced hypomania may be a true side-effect of drug.
In the last decade, data from both animal and human studies have been suggested that serotonin has more associated with impulsive aggression than with aggression subtypes, with more “waiting impulsivity” in impulsivity subtypes.
They found that serotonin produced by these cells is a signal to other neurons in the circuit, leading to an increase in anxiety.
Research suggests schizophrenia may be caused by a change in the level of 2 neurotransmitters: dopamine and serotonin. Some studies indicate an imbalance between the 2 may be the basis of the problem. Others have found a change in the body's sensitivity to the neurotransmitters is part of the cause of schizophrenia.
In addition to depression, serotonin may play a role in other brain and mental health disorders, including anxiety disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), phobias, and even epilepsy.
And female hormones and reproductive factors may influence the condition and its treatment. Research suggests that in women, hormones may play a role in the development and severity of bipolar disorder. One study suggests that late-onset bipolar disorder may be associated with menopause.
Antidepressants “have the propensity to destabilize mood, precipitating both hypomanic and manic episodes”—a phenomenon called antidepressant associated hypomania (AAH).
As for the timing of antidepressant‐induced mania and rapid cycling, most case reports describe manic symptoms that develop a few days to 2 weeks after starting serotonin reuptake inhibitors (SSRI), and resolution of symptoms within 2 weeks after discontinuation of the medication.
The phenomenon of antidepressant-induced mania/hypomania in patients with unipolar depression has been described since the introduction of the first antidepressant agents. The hypothesis was that antidepressant agents triggered manic/hypomanic symptoms by influencing the central dopamine and serotonin systems (1).
Lithium and quetiapine top the lists for all three phases of the illness: mania, depression, and the maintenance phase. Lurasidone and lamotrigine are either untested (lurasidone) or ineffective (lamotrigine) in mania, but they are essential tools for bipolar depression.
Chemical imbalance in the brain
For example, there's evidence that episodes of mania may occur when levels of noradrenaline are too high, and episodes of depression may be the result of noradrenaline levels becoming too low.
Abstract. The findings on dopamine in mood disorders suggest that decreased dopamine activity is involved in depression, while increased dopamine function contributes to mania.
Medications such as Zoloft may trigger bipolar mania or hypomania, so careful monitoring by a physician is needed.
Treating bipolar depression with antidepressants remains a popular option in clinical practice and published guidelines. Most clinicians choose the drug or class of drugs, usually selective serotonin reuptake inhibitors and bupropion, that is most effective and best tolerated.
Antidepressants can trigger mania in people with bipolar disorder. If antidepressants are used at all, they should be combined with a mood stabilizer such as lithium or valproic acid. Taking an antidepressant without a mood stabilizer is likely to trigger a manic episode. Antidepressants can increase mood cycling.