Summary
Mania can occur by chance association during drug treatment, particularly in patients predisposed to mood disorder. Single case reports are unreliable, and evidence must be sought from large series of treated patients, particularly those with a matched control group. Drugs with a definite propensity to cause manic symptoms include levodopa, corticosteroids and anabolic-androgenic steroids. Antidepressants of the tricyclic and monoamine oxidase inhibitor classes can induce mania in patients with pre-exisdng bipolar affective disorder. Drugs which are probably capable of inducing mania, but for which the evidence is less scientifically secure, include other dopaminergic anti-Parkinsonian drugs, thyroxine, iproniazid and isoniazid, sympathomimetic drugs, chloroquine, baclofen, alprazolam, captopril, amphetamine and phencyclidine. Other drugs may induce mania rarely and idiosyncratically.
Management involves discontinuation or dosage reduction of the suspected drug, if this is medically possible, and treatment of manic symptoms with anti-psychotic drugs or lithium.
Similar content being viewed by others
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994: 317–91
Leff JP, Fischer M, Bertelsen A. A cross-national epidemiological study of mania. Br J Psychiatry 1976; 129: 428–42
Sultzer DL, Cummings JL. Drug-induced mania-causative agents, clinical and characteristics and management. Med Toxicol Adverse Drug React 1989; 4: 127–43
Krauthammer C, Klerman GL. Secondary mania. Arch Gen Psychiatry 1978; 35: 1333–9
Cotzias GC, van Woert MH, Schiffer LM. Aromatic amino acids and modification of Parkinsonism. N Engl J Med 1967; 276: 374
Goodwin FK. Psychiatric side-effects of levodopa in man. JAMA 1971; 218: 1915–20
Presthus J, Holmsen R. Appraisal of long-term levodopa treatment of parkinsonism with special reference to therapy-limiting factors. Acta Neurol Scand 1974; 50: 774–90
Lin JT-Y, Zeigler D. Psychiatric symptoms with initiation of carbidopa-levodopa treatment. Neurology 1976; 26: 679–700
Harsch HH, Miller M, Young LD. Induction of mania by 1-dopa in a nonbipolar patient. J Clin Psychopharmacol 1985; 5: 338–9
Mindham RHS. Psychiatric symptoms in Parkinsonism. J Neurol Neurosurg Psychiatry 1970; 33: 188–91
Mindham RHS. Psychiatric aspects of Parkinson’s disease. Br J Hosp Med 1974; 11: 411–4
Van Woert MH, Ambani LM, Weintraub MI. Manic behaviour and levodopa. N Engl J Med 1971; 285: 1326
Murphy DL, Brodie HKH, Goodwin FK, et al. Regular induction of hypomania by 1-dopa in bipolar manic-depressive patients. Nature 1971; 229: 135–6
Jouvent R, Abensour P, Bonnet AM, et al. Antiparkinsonian and antidepressant effects of high doses of bromocriptine. J Affect Disord 1983; 5: 141–5
Turner TH, Cookson JC, Wass JAH, et al. Psychotic reactions during treatment of pituitary tumours with dopamine agonists. BMJ 1984; 289: 1101–3
Brook NM, Cookson IB. Bromocriptine-induced mania? BMJ 1978; 1: 790
Vlissides DN, Gill D, Castelow J. Bromocriptine-induced mania? BMJ 1978; 1: 510
Lake CR, Reid A, Martin C, et al. Cyclothymic disorder and bromocriptine: predisposing factors for postpartum mania? Can J Psychiatry 1987; 32: 693–4
Menza MA, Cölbe LI. Hypomania in a patient receiving deprenyl (selegiline) after adrenal-striatal transplantation of Parkinson’s disease. Clin Neuropharmacol 1988; 11: 549–50
Kurlan R, Dimitsopoulos T. Selegiline and manic behaviour in Parkinson’s disease. Arch Neurol 1992; 49: 1231
Suchowersky O, de Vries JD. Interaction of fluoxetine and selegiline. Can J Psychiatry 1990; 35: 571–2
Przedborski S, Liard A, Hildebrand J. Induction of mania by apomorphine in a depressed Parkinsonian patient. Mov Disord 1992; 7: 285–6
Pearlman CA. Manic behaviour and levodopa. N Engl J Med 1971; 285: 1326
Ryback RS, Schwab RS. Manic behaviour and levodopa. N Engl J Med 1971; 285: 788–9
Jeffcoate WJ, Silverstone JT, Edwards CRW, et al. Psychiatric manifestations of Cushing’s syndrome: response to lowering of plasma cortisol. Q J Med 1979; 191: 465–72
Hall RCW, Popkin MK, Stickney SK, et al. Presentation of the steroid psychoses. J Nerv Ment Dis 1979; 167: 229–36
Sergent JS, Lockshin MD, Klempner MS, et al. Central nervous system disease in systemic lupus erythematosus. Am J Med 1975; 58: 644–54
Lewis DA, Smith RE. Steroid-induced psychiatric syndromes. J Affect Disord 1983; 5: 319–32
Cade R, Spooner G, Schlein E, et al. Comparison of azathio-prine, prednisone and heparin alone or together in treating lupus nephritis. Nephron 1973; 10: 37–56
Marx FW, Barker WF. Surgical results in patients with ulcerative colitis treated with and without corticosteroids. Am J Surg 1967; 113: 157–63
Boston Collaborative Drug Surveillance Programme. Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther 1972; 13: 694–8
Sharfstein SS, Sack DS, Fauci AS. Relationship between alternate-day corticosteroid therapy and behavioural abnormalities. JAMA 1982; 248: 2987–9
Falk WE, Mahnke MW, Poskanzer DC. Lithium prophylaxis of corticotropin-induced psychosis. JAMA 1979; 242: 1011–2
Minden SL, Orav J, Schildkraut JJ. Hypomanic reactions to ACTH and prednisone treatment for multiple sclerosis. Neurology 1988; 38: 1631–4
Glaser GH. Psychotic reactions induced by corticotrophin (ACTH) and cortisone. Psychosom Med 1953; 15: 280–91
Phelan MC. Beclomethasone mania. Br J Psychiatry 1989; 155: 871–2
Ling MHM, Perry PJ, Tsnang MT. Side effects of corticosteroid therapy — psychiatric aspects. Arch Gen Psychiatry 1981; 38: 471–7
Griggs RC, Pandya S, Florence JM, et al. Randomised controlled trial of testosterone in myotonic dystrophy. Arch Gen Psychiatry 1989; 39: 375–82
Su TP, Pagliaro M, Ollo C, et al. Neuropsychiatric effects of anabolic steroids. JAMA 1993; 269: 2760–4
Pope HG, Katz DL. Psychiatric and medical effects of anabolicandrogenic steroid use. Arch Gen Psychiatry 1994; 51: 375–82
Bahrke MS, Wright JE, Strauss RH, et al. Psychological moods and subjectively perceived behavioural and somatic changes accompanying anabolic-androgenic steroid use. Am J Sports Med 1992; 20: 717–24
Ball JRB, Kiloh LG. A controlled trial of imipramine in treatment of depressive states. BMJ 1959; 2: 1052–5
Bunney WE. Psychopharmacology of the switch process in affective illness. In: Lipton MA, Kellam KF, editor. Psychopharmacology: a generation of progress. New York: Raven Press, 1978: 1249–59
Lewis JL, Winokur G. The induction of mania: a natural history study with controls. Arch Gen Psychiatry 1982; 39: 303–6
Wehr TA, Goodwin FK. Can antidepressants cause mania and worsen the course of affective illness? Am J Psychiatry 1987; 144: 1403–11
Angst J, Angst K, Baruffol I, et al. ECT-induced and drug-induced hypomania. Convulsive Ther 1992; 8: 179–85
Peet M. Induction of mania with selective serotonin reuptake inhibitors and tricyclic antidepressants. Br J Psychiatry 1994; 164: 549–50
Settle EC, Settle GP. Acase of mania associated with fluoxetine. Am J Psychiatry 1984; 141: 280–1
Lebuegue B. Mania precipitated by fluoxetine. Am J Psychiatry 1987; 144: 1620
Nakra BRS, Szwabo P, Grossberg GT. Mania induced by fluoxetine. Am J Psychiatry 1989; 146: 1515–6
Montgomery SA, Roberts A. SSRIs: well tolerated treatment for depression. Hum Psychopharmacol 1994; 9: S7–S10
Jabeen S, Fischer CJ. Trazodone-induced transient hypomanic symptoms and their management. Br J Psychiatry 1991; 158: 275–8
Terao T. Comparison of manic switch onset during fluoxetine and trazodone treatment. Biol Psychiatry 1993; 33: 477–8
Fogelson DL, Bystritsky A, Pasnau R. Bupropion in the treatment of bipolar disorders: the same old story? J Clin Psychiatry 1992; 53: 443–6
Masand P, Stern TA. Bupropion and secondary mania: is there a relationship? Ann Clin Psychiatry 1993; 5: 271–4
Mirin SM, Schatzberg AF, Creasey DE. Hypomania and mania after withdrawal of tricyclic antidepressants. Am J Psychiatry 1981; 138: 87–9
McGrath PJ, Stewart JW, Tricamo E, et al. Paradoxical shifts to euthymia or hypomania upon withdrawal of antidepressant drugs. J Clin Psychopharmacol 1993; 13: 224–5
Mander AJ, Loudon JB. Rapid recurrence of mania following abrupt discontinuation of lithium. Lancet 1988; 2: 15–7
Suppes T, Baldessarini RJ, Faedda GL, et al. Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Arch Gen Psychiatry 1991; 48: 1082–8
Faedda GL, Tondo L, Baldessarini RJ, et al. Outcome after rapid vs gradual discontinuation of lithium treatment in bipolar disorders. Arch Gen Psychiatry 1993; 50: 448–55
Quitkin FM, Kane J, Rifkin A, et al. Prophylactic lithium carbonate with and without imipramine for bipolar patients: a double-blind study. Arch Gen Psychiatry 1981; 38: 902–7
Prien RF, Kupfer DJ, Mansky PA, et al. Arch Gen Psychiatry 1984; 41: 1096–104
Akhtar S, Mukherjee S. Chloroquine induced mania. Int J Psychiatry Med 1993; 23: 349–56
Bhatia MS, Singhal PK, Dhar NK. Psychiatric complications of chloroquine. Ann Nat Acad Med Sci (India) 1988; 24: 223–8
Lovestone S. Chloroquine-induced mania. Br J Psychiatry 1991; 159: 164–5
Josephson AM, Mackenzie TB. Thyroid-induced mania in hypothyroid patients. Br J Psychiatry 1980; 137: 222–8
Evans DL, Strawn SK, Haggerty JJ, et al. Appearance of mania in drug-resistant bipolar depressed patients after treatment with 1-triiodothyronine. J Clin Psychiatry 1986; 47: 521–2
Bloch RC, Dooneief AS, Buchberg AS, et al. The clinical effects of isoniazid and iproniazid in the treatment of pulmonary tuberculosis. Ann Intern Med 1954; 40: 881–900
Crane GE. The psychiatric side-effects of iproniazid. Am J Psychiatry 1956; 112: 494–501
Wood KA. Nasal decongestant and psychiatric disturbance. Br J Psychiatry 1994; 164: 566–7
Lake CR. Manic psychosis after coffee and phenylpropanolamine. Biol Psychiatry 1991; 30: 401–4
Lake CR, Gallant S, Masson E, et al. Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports. Am J Med 1990; 89: 195–208
Lake CR, Tenglin R, Chernow B, et al. Psychomotor stimulant-induced mania in a genetically predisposed patient a review of the literature and report of a case. J Clin Psychopharmacol 1983; 3: 97–100
Roxanas MG, Spalding J. Ephedrine abuse psychosis. Med J Aust 1977; 2: 639–40
Waters BG, Lapierre YD. Secondary mania associated with sympathomimetic drug use. Am J Psychiatry 1981; 138: 837–8
Jones RF, Lance JW. Baclofen in the long-term management of spasticity. Med J Aust 1976; 1: 654–7
Wolf ME, Almy G, Toll M, et al. Mania associated with the use of baclofen. Biol Psychiatry 1982; 17: 757–9
Yassa RY, Iskandar HL. Baclofen-induced psychosis: two cases and a review. J Clin Psychiatry 1988; 49: 318–20
Stewart JT. A case of mania associated with high-dose baclofen therapy. J Clin Psychopharmacol 1992; 12: 215–7
Arnold ES, Rudd SM, Kirshner H. Manic psychosis following rapid withdrawal from baclofen. Am J Psychiatry 1980; 137: 1466–7
Rottanburg D, Ben-Arie O, Robins AH, et al. Cannabis-associated psychosis with hypomanic features. Lancet 1982; 2: 1364–6
McGuire P, Jones P, Murray R. Psychiatric symptoms in cannabis users. Br J Psychiatry 1993; 163: 698
Thomas H. Psychiatric symptoms in cannabis users. Br J Psychiatry 1993; 163: 141–9
Jacobs D, Silverstone T. Dextroamphetamine induced arousal in human subjects as a model for mania. Psychol Med 1986; 16: 323–9
Gerner RM, Post RM, Bunney WE. A dopaminergic mechanism in mania. Am J Psychiatry 1976; 113: 1177–80
Van Kammen DP, Murphy DL. Attenuation of the euphoriant effect and activating effects of d- and d-amphetamine by lithium carbonate treatment. Psychopharmacology 1975; 44: 215–24
Slavney PR, Rich GB, Pearlson GD, et al. Phencyclidine abuse and symptomatic mania. Biol Psychiatry 1977; 12: 697–9
Rosen A. Case report: symptomatic mania and phencyclidine abuse. Am J Psychiatry 1979; 136: 118–9
Cole JO, Kando JC. Adverse behavioural events reported in patients taking alprazolam and other benzodiazepines. J Clin Psychiatry 1993; 54 Suppl.: 49–61
Gajula RP, Berlin RM. Captopril-induced mania. Am J Psychiatry 1993; 150: 1429–30
Patten SB, Brager N, Sander S. Manic symptoms associated with the use of captopril. Can J Psychiatry 1991; 36: 314–5
McMahon T. Bipolar affective symptoms associated with use of captopril and abrupt withdrawal of pargyline and propranolol. Am J Psychiatry 1985; 142: 759–60
Post RM. Effectiveness of carbamazepine in the treatment of bipolar affective disorder. In: McElroy SL, Pope HG. editors. Use of anticonvulsants in psychiatry. Clifton, NJ: Oxford Health Care, 1988: 1–24
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Peet, M., Peters, S. Drug-Induced Mania. Drug-Safety 12, 146–153 (1995). https://doi.org/10.2165/00002018-199512020-00007
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002018-199512020-00007