# The Emergence of Mania After Initiating Escitalopram for Anxiety Disorder

## TL;DR

A young woman developed mania after starting escitalopram for anxiety, highlighting the risk of antidepressants triggering bipolar symptoms.

## Contribution

This case report highlights the risk of bipolar switch with escitalopram in patients without prior bipolar disorder history.

## Key findings

- A 22-year-old patient developed mania five days after starting escitalopram.
- The patient's symptoms resolved after discontinuing escitalopram and starting divalproex and olanzapine.
- The case suggests antidepressants may trigger bipolar symptoms in susceptible individuals.

## Abstract

The abrupt transition into mania, known as a bipolar switch, poses a significant challenge in the treatment of mental illnesses. We present a case of a 22-year-old Hispanic female with generalized anxiety disorder (GAD) and autism spectrum disorder (ASD) who developed mania within five days after initiating escitalopram 5 mg. The patient had no reported history of bipolar disorder prior to this episode, and an extensive medical workup ruled out organic causes. The patient was in the acute inpatient psychiatric unit for 25 days and returned to baseline after discontinuation of escitalopram and initiating divalproex and olanzapine. This case underscores the potential risk of a bipolar switch with antidepressant use and highlights the importance of vigilant monitoring and considering underlying bipolarity in such patients.