Social Psychiatry, Vol. 54 No. 2, 2026.
Meeting abstract
https://doi.org/10.24869/spsih.2026.330
Manic Episode Following the Initiation of Escitalopram as the First Manifestation of Bipolar Disorder – A Case Report
Tea Vukićević
; Institute of Naval Medicine, Ministry of Defence of the Republic of Croatia, Šoltanska 1, 21000 Split, Croatia; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
*
Marina Mustapić
; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Kristina Divić
; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Jelena Popović
; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
* Corresponding author.
Abstract
Aim of the study: To present a patient with an
initial presentation of unipolar depression who,
after initiation of escitalopram, developed a
pharmacologically induced switch into a manic
episode, and to analyze the challenges in distinguishing
unipolar depression from a first episode
of bipolar affective disorder (BAD). Materials
and methods: Medical records were analyzed for
a patient who presented for the first time to psychiatric
evaluation due to depressive symptoms
(low mood, loss of interest, reduced energy, sleep
disturbance, concentration difficulties), without
previous manic/hypomanic phases and without
prior psychiatric treatment. Escitalopram was initially introduced at a dose of 10 mg/day. Results:
Within several weeks of antidepressant initiation,
there was a dramatic change in the clinical
picture with the development of a classic manic
episode (elevated mood, decreased need for sleep,
increased energy, accelerated flow of thoughts,
logorrhea, increased self-confidence, impulsive
behavior, impaired judgment). Due to symptom
progression, inpatient treatment was indicated.
The antidepressant was discontinued, and a mood
stabilizer and an antipsychotic were introduced,
followed by gradual symptom remission and stabilization
of the condition. Conclusion: This case
report highlights the importance of evaluating
hidden risk factors and soft signs of bipolarity
before introducing antidepressants. Antidepressant-
induced mania has high diagnostic value for
detecting previously unrecognized bipolar disorder,
and routine use of clinical screening tools
(such as the MDQ) in patients with depression
could optimize therapeutic outcomes.
Keywords
bipolar affective disorder; escitalopram; antidepressant‑induced mania; case report
Hrčak ID:
353019
URI
Publication date:
15.6.2026.
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