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  1. https://www.researchgate.net/post/Antidepressant_induced_Hypomania_or_antidepressant_induced_ADHD_exacerbation
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  5. [Ahmet Koyuncu]
  6. Ahmet Koyuncu 21.14
  7. akademi social phobia center
  8. Antidepressant induced Hypomania or antidepressant induced ADHD exacerbation?
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  10. I think that there might be an association between hypomanic switch in SAD patients and ADHD.
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  12. In our study (Koyuncu et al. 2012) that includes 108 SAD patients, bipolar disorder occurred under antidepressant treatment in 14 of 16 patients with bipolar disorder comorbidity. Hypomanic switch induced by antidepressant was found to be higher in SAD patients with ADHD comorbidity (26.5%) than those without comorbidity (0%). Fifty-six of 108 social phobia patients (51.8%) were under antidepressant treatment for at least one month. Fourteen of those 56 patients (25%) had hypomanic switch. Interesting part of the picture was that switch occurred only in SAD group that had ADHD comorbidity.
  13. There are studies regarding switching in patients with SAD. It was reported that 18 out of 32 patients treated with a monoamine oxidase inhibitor (MAOI) have remitted while 14 of those patients developed hypomanic symptoms (Himmelhoch, 1998). Among patients with major depression, antidepressants were more related to hypomanic switches in the presence of SAD comorbidity (Holma et al., 2008). In our study, the switch rate was lower than in Himmeloch’s study.
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  15. As it is known, the validity of the antidepressant induced hypomania concept is controversial. Is it induced by antidepressant or caused by nature of disorder? (Levis and Winokur, 1982; Tondo et al. 2010 )
  16. Akiskal and Malya included antidepressant induced hypomania in soft bipolar spectrum in 1987. Himmelhoch suggested that a group of social phobia patients who had switch might be within the bipolar spectrum and that bipolar characteristics might appear by antidepressant treatment (Himmelhoch, 1998). In our study, we found that social phobics with ADHD comorbidity had switched with antidepressant treatment.
  17. Antidepressants might increase the likelihood of mood elevation in some sensitive patients regardless of the clinical diagnosis. (Wehr & Goodwin, 1987; Ghaemi et al., 2004; Tondo et al., 2010). Considering these publications, ADHD patients who have similar symptoms with bipolar disorder might be one of the sensitive patient groups for the switch mentioned in those studies. It means that those with ADHD comorbidity might switch from ADHD to bipolar spectrum under antidepressant medication regardless of the primary diagnosis.
  18. Although it is claimed that antidepressant induced hypomania should not be classified in a different category because it belongs to the course of bipolar disorder (Chun and Dunner , 2004), it might take place in the border between ADHD and bipolar disorder. Antidepressants might be taking patients from ADHD to bipolar spectrum.
  19. Our patients who went through a hypomanic switch under antidepressant treatment (especially patients with a combined or hyperactive type ADHD comorbidity) claim that they come back to the way they used to be. They report becoming hyperactive, impatient and very talkative people who can not stand still, who talk and take risks without much thinking. They say to me “These characteristics were diminished, but now they came back but this time I am very happy and more self-confident.” Our theory is that antidepressant induced hypomania might be an exacerbation of ADHD in patients with SAD. Prescribing antidepressants to an ADHD patient might exacerbate ADHD like pouring gasoline on fire. ADHD comorbidity in SAD must alert clinicians regarding the occurrence of possible switches or bipolar disorder. New studies that explain these issues are warranted.
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  24. Comments and his replies and elaborations:
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  26. Martin Cederlöf · 20.10 · 59.28 · Karolinska Institutet
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  28. Perhaps this paper is of interest: http://journals.psychiatryonline.org/Article.aspx?ArticleID=1882900
  29. Jul 22, 2014
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  32. [Béatrice Marianne Ewalds-Kvist]
  33. Béatrice Marianne Ewalds-Kvist · 181.68 · 41.62 · Stockholm University
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  35. "Hypomanic switch induced by antidepressant was found to be higher in SAD patients with ADHD comorbidity (26.5%)" Did this group have additional medication for ADHD?
  36. 1 / 0 · Jul 22, 2014
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  39. [Ahmet Koyuncu]
  40. Ahmet Koyuncu · 21.14 · 35.35 · akademi social phobia center
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  42. These patients were also assessed for childhood ADHD by K- SADS PL, ADHD module and for current adult ADHD by clinical interview. This instrument was used in previous studies to retrospectively assess the childhood psychopathology. Childhood or adulthood ADHD was assessed by DSM-IV diagnostic criteria [APA 1994]. Any patients were not receiving ADHD treatment.
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  44. Morever In a related study investigating childhood ADHD in SAD patients, the rate of lifetime bipolar disorder comorbidity was found to be higher in childhood SAD- ADHD group than in SAD- without ADHD group (Koyuncu et al. 2014). Koyuncu et al. 2014a utilized K - SADS- PL’s (Schedule for Affective Disorders and Schizophrenia for School Age Children—Present and Lifetime Version) ADHD module in 130 patients with primary diagnosis of SAD and 94 patients were found to meet childhood ADHD diagnostic criteria according to APA 1994 criteria. The study noted the relation between ADHD inattentive type and SAD, and reported that in presence of comorbid ADHD, the severity of SAD increases, functionality decreases and the course of SAD is affected.
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  46. Presence of ADHD in SAD patients should alert clinician for switch and occurrence of bipolar disorder. This possibility must be kept in mind when prescribing antidepressant treatment to SAD patients with ADHD and patients should be monitored carefully. Yours faith fully...
  47. 1 / 0 · Jul 22, 2014
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  51. [Kurt Wahlstedt]
  52. Kurt Wahlstedt · 23.63 · 66.61 · Uppsala University
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  54. This is a very interesting finding. We have in Uppsala performed several studies on SAD who were treated double blind with antidepressants and placebo. In all these studies bipolarity and ADHD tested by SCID and/or MINI were exclusion criteria. We did not diagnose any hypomanic outcomes. However, a couple of patients responded to antidepressants with excessive and fast improvement, from at least moderate SAD to be almost symptomless. We will now make a closer look on those cases, considering your results. Best regards...
  55. Jul 30, 2014
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  59. [Ahmet Koyuncu]
  60. Ahmet Koyuncu · 21.14 · 35.35 · akademi social phobia center
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  62. Thank you. Therefore, social phobia patients are divided into two groups by Dr.Ahmet Koyuncu Social Phobia Center as follows :
  63. 1) Social Phobia without ADHD comorbidity
  64. 2) Social Phobia with ADHD comorbidity
  65. In accordance with this classification, the following treatment approach is applied for social phobia patients.
  66. Social Phobia without ADHD comorbidity = Normal Social Phobia Algorithm
  67. Social Phobia + ADHD comorbidity = Simultaneous Social Phobia Treatment + ADHD treatment
  68. In social phobia patients with ADHD comorbidity, abovementioned approach with simultaneous social phobia + ADHD treatment (i.e. simultaneous antidepressant + Concerta or Atomoxetine treatment) establishes Dr.Ahmet Koyuncu’s “dual approach model” in social phobia treatment. I apply this approach model in my own clinic successfully and obtain significant results. Currently, about 200 patients are regularly treated by Antidepressant + Concerta.
  69. When I prescribe Concerta in addition to antidepressant medication in social phobia patients, response to treatment is more rapid and more consistent. Concerta potentializes social phobia response of antidepressants in social phobics with ADHD comorbidity. Moreover, in our studies, we found that antidepressant induced hypomania is related with ADHD and it occurs only in social phobics with ADHD comorbidity. We also found that when antidepressant is taken together with Concerta, hypomania induced by antidepressant does not occur. Concerta prevents development of switch in social phobics with ADHD as well as regulating mood instability in these patients.
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  71. Morever, in our current report, we presented two cases with SAD and ADHD comorbidity who responded well to extended-release methylphenidate monotherapy ( in publication acsess). In both cases, symptoms of SAD and ADHD improved simultaneously by extended-release methylphenidate treatment without using any approved medication for the treatment of SAD. These findings are in line with those of Golubchik et al. (2014) who reported similar findings in a group of children and adolescents with SAD and ADHD comorbidity. Our findings suggest that Golubchik et al. (2014)’s findings might also be valid for adult population. Also, Adler et al. (2009) found that atomoxetine monotherapy is more efficient than placebo in SAD/ADHD group.
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  73. Extended-release methylphenidate treatment in two patients with SAD/ADHD inattentive type led to a decrease in both SAD and ADHD scores. Further comprehensive studies on SAD and ADHD (particularly inattentive type ADHD) comorbidity and on contributions of stimulant and non-stimulant ADHD treatment are warranted. Best regards...
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