[When an antidepressant helps too much].

Initiation of an antidepressant may result in hypomania or mania. The risk is lower with selective serotonin reuptake inhibitors and bupropione than with venlafaxine and tricyclic antidepressants. With a mood-stabilizing medication, the risk of hypomania or mania will remain very low, along with its correspondingly lower efficacy. The therapy involves discontinuation of the antidepressant, initiation or dose elevation of a maintenance drug preventing hypomania and mania, and when needed, short-course use of a second generation antipsychotic.