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Drug-Induced Mania in the Elderly

  • Physiological Aspects of Aging
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Summary

Mania is a rare complication of prescribed drug use in elderly persons. The drugs most likely to produce mania include corticosteroids and dopamine agonists. It is uncertain if antidepressants cause mania or only increase the propensity for latent bipolar mania to be expressed.

Drug-induced mania may promote poor judgment, risk-taking behaviours and medical noncompliance. The majority of episodes of drug-induced mania are short-lived and respond to discontinuation of the drug. Antipsychotic agents may hasten resolution of this psychiatric syndrome. Lithium may prevent corticosteroid-induced mania, but the role of lithium in the treatment of other drug-induced manic episodes has not been studied adequately.

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References

  • Abramowicz M (Ed.). Drugs that cause psychiatric symptoms. Medical Letter on Drugs and Therapeutics 31: 113–118, 1989

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., Revised, APA Press, Washington, DC, 1987

  • Arana GW, Pearlman C, Shader RI. Alprazolam-induced mania: two clinical cases. American Journal of Psychiatry 142: 368–369, 1985

    PubMed  CAS  Google Scholar 

  • Beresin EV. Delirium in the elderly. Journal of Geriatric Psychiatry and Neurology 1: 127–143, 1988

    Article  PubMed  CAS  Google Scholar 

  • Boston Collaborative Drug Surveillance Program. Acute adverse reactibns to prednisone in relation to dosage. Clinical Pharmacology and Therapeutics 13: 694–698, 1972

    Google Scholar 

  • Broadhead J, Jacoby R. Mania in old age: a first prospective study. International Journal of Geriatric Psychiatry 5: 215–222, 1990

    Article  Google Scholar 

  • Cade R, Spooner G, Shlein E, Pickering M, de Quesada A. Comparison of azathioprine, prednisone and heparin alone or combined in treating lupus nephritis. Nephron 10: 37–56, 1973

    Article  PubMed  CAS  Google Scholar 

  • Calne DB, Stern GM, Laurence DR, Sharkey J, Armitage P. L-dopa in postencephalitic parkinsonism. Lancet 1: 744–747, 1969

    Article  PubMed  CAS  Google Scholar 

  • Casey DE. Clozapine: neuroleptic-induced EPS and tardive dyskinesia. Psychopharmacology 99: S47–S53, 1989

    Article  PubMed  Google Scholar 

  • Celesia GG, Barr AN. Psychosis and other psychiatric manifestations of levodopa therapy. Archives of Neurology 23: 193–200, 1970

    Article  PubMed  CAS  Google Scholar 

  • Chouinard G, Steiner W. A case of mania induced by high dose fluoxetine treatment. American Journal of Psychiatry 143: 686, 1986

    PubMed  CAS  Google Scholar 

  • Delerue O, Muller JP, Destee A, Warot P. Mania-like episodes associated with ranitidine. American Journal of Psychiatry 145: 271, 1988

    PubMed  CAS  Google Scholar 

  • Dorevitch A. Mania associated with clonazepam. Drug Intelligence and Clinical Pharmacy 25: 938–939, 1991

    CAS  Google Scholar 

  • Eagles JM, Whalley LJ. Ageing and affective disorders: the age at first onset of affective disorders in Scotland, 1966-1987. British Journal of Psychiatry 147: 180–187, 1985

    Article  PubMed  CAS  Google Scholar 

  • Factor SA, Brown D. Clozapine prevents recurrence of psychosis in Parkinson’s disease. Movement Disorders 7: 125–131, 1992

    Article  PubMed  CAS  Google Scholar 

  • Falk WE, Mahnke MW, Poskanzer DC. Lithium prophylaxis of corticotropin-induced psychosis. Journal of the American Medical Association 241: 1011–1012, 1979

    Article  PubMed  CAS  Google Scholar 

  • Feder R. Fluoxetine-induced mania. Journal of Clinical Psychiatry 51: 524–525, 1990

    PubMed  CAS  Google Scholar 

  • Fichtner CG, Brown BG. Bupropion-associated mania in a patient with HIV infection. Journal of Clinical Psychopharmacology 12: 366–367, 1992

    Article  PubMed  CAS  Google Scholar 

  • Friedman JH, Lannon MC. Clozapine in the treatment of psychosis in Parkinson’s disease. Neurology 39: 1219–1221, 1989

    Article  PubMed  CAS  Google Scholar 

  • Glasser M, Rabins P. Mania in the elderly. Age and Ageing 13: 210–213, 1984

    Article  PubMed  CAS  Google Scholar 

  • Godwin-Austin RB, Tomlinson EB, Frears CC, Kok HWL. Effects of l-dopa in Parkinson’s disease. Lancet 2: 165–168, 1969

    Article  Google Scholar 

  • Goodwin FK, Jamison KR. Manic-depressive illness, Oxford University Press, New York, 1990

    Google Scholar 

  • Hall RCW, Popkin MK, Stickney SK, Gardner ER. Presentation of the steroid psychoses. Journal of Nervous and Mental Disease 167: 229–236, 1979

    Article  PubMed  CAS  Google Scholar 

  • Harsch HH, Miller M, Young LD. Induction of mania by l-dopa in a nonbipolar patient. Journal of Clinical Psychopharmacology 5: 338–339, 1985

    PubMed  CAS  Google Scholar 

  • Hubain PP, Sobolski J, Mendlewicz J. Cimetidine-induced mania. Neuropsychobiology 8: 223–224, 1982

    Article  PubMed  CAS  Google Scholar 

  • Jabeen S, Fisher CJ. Trazodone-induced transient hypomanic symptoms and their management. British Journal of Psychiatry 158: 275–278, 1991

    Article  PubMed  CAS  Google Scholar 

  • Josephson AM, MacKenzie TB. Thyroid-induced mania in hypothyroid patients. British Journal of Psychiatry 137: 222–228, 1980

    Article  PubMed  CAS  Google Scholar 

  • Jouvent R, Abensour P, Bonnet AM, Widlocher D, Agid Y, et al. Antiparkinsonian and antidepressant effects of high doses of bromocriptine. Journal of Affective Disorders 5: 141–145, 1983

    Article  PubMed  CAS  Google Scholar 

  • Kahn N, Freeman A, Juncos JL, Manning D, Watts RL. Clozapine is beneficial for psychosis in Parkinson’s disease. Neurology 41: 1699–1700, 1989

    Article  Google Scholar 

  • Kaufmann MW, Cassadonte PE, Peselow ED. Steroid psychosis. New York State Journal of Medicine 81: 1795–1797, 1981

    PubMed  CAS  Google Scholar 

  • Kershner P, Wang-Cheng R. Psychiatric side effects of steroid therapy. Psychosomatics 30: 135–139, 1989

    Article  PubMed  CAS  Google Scholar 

  • Knobler HY, Itzchaky S, Emanuel D, Mester R, Maizel S. Trazodone-induced mania. British Journal of Psychiatry 149: 787–789, 1986

    Article  PubMed  CAS  Google Scholar 

  • Ko GN, Leckman JF, Henninger GR. Induction of rapid mood cycling during L-dopa treatment in a bipolar patient. American Journal of Psychiatry 138: 1624–1625, 1981

    PubMed  CAS  Google Scholar 

  • Kupfer DJ, Carpenter LL, Frank E. Possible role of antidepressants in precipitating mania and hypomania in recurrent depression. American Journal of Psychiatry 145: 804–808, 1988

    PubMed  CAS  Google Scholar 

  • Kurlan R, Dimitsopulos T. Selegiline and manic behaviour in Parkinson’s disease. Archives of Neurology 49: 1231, 1992

    Article  PubMed  CAS  Google Scholar 

  • Krauthammer C, Klerman GL. Secondary mania: manic syndromes associated with antecedent physical illness or drugs. Archives of General Psychiatry 35: 1333–1339, 1978

    Article  PubMed  CAS  Google Scholar 

  • Lewis DA, Smith RE. Steroid-induced psychiatric syndromes: a report of 14 cases and a review of the literature. Journal of Affective Disorders 5: 319–332, 1983

    Article  PubMed  CAS  Google Scholar 

  • Lin JT, Ziegler DK. Psychiatric symptoms with initiation of carbidopa-levodopa treatment. Neurology 26: 699–700, 1976

    Article  PubMed  CAS  Google Scholar 

  • Ling MHM, Perry PJ, Tsuang MT. Side effects of corticosteroid therapy. Archives of General Psychiatry 38: 471–477, 1981

    Article  PubMed  CAS  Google Scholar 

  • Lipowski ZJ. Delirium: acute confusional states, Oxford University Press, New York, 1990

    Google Scholar 

  • Muenter MD. Double-blind, placebo-controlled study of levodopa therapy in Parkinson’s disease. Neurology 20: 6–13, 1970

    Article  CAS  Google Scholar 

  • Murphy DL, Brodie HKH, Goodwin FK, Bunney WE. Regular induction of hypomania by l-dopa in bipolar’ manic-depressive patients. Nature 229: 135–136, 1971

    Article  PubMed  CAS  Google Scholar 

  • O’Brien CP, DiGiacon JN, Fahn S, Schwarz GA. Mental Effects of high-dosage levodopa. Archives of General Psychiatry 24: 61–64, 1971

    Article  PubMed  Google Scholar 

  • Patten SB, Brager N, Sanders S. Manic symptoms associated with the use of captopril. Canadian Journal of Psychiatry 36: 314–315, 1991

    CAS  Google Scholar 

  • Patterson JF. Mania associated with intravenous ranitidine therapy. Southern Medical Journal 80: 1467, 1987

    Article  PubMed  CAS  Google Scholar 

  • Perry PJ, Tsuang MT, Hwang MH. Prednisolone psychosis: clinical observations. Drug Intelligence and Clinical Pharmacy 18: 603–609, 1984

    PubMed  CAS  Google Scholar 

  • Pfeiffer RF, Kang J, Graber B, Hofman R, Wilson J. Clozapine for psychosis in Parkinson’s disease. Movement Disorders 5: 239–242, 1990

    Article  PubMed  CAS  Google Scholar 

  • Pope HG, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use. American Journal of Psychiatry 145: 487–490, 1988

    PubMed  Google Scholar 

  • Presthus J, Holmsen R. Appraisal of long-term levodopa treatment of parkinsonism with special reference to therapy limiting factors. Acta Neurologica Scandinavica 50: 774–790, 1974

    Article  PubMed  CAS  Google Scholar 

  • Przedborski S, Liard A, Hildebrand J. Induction of mania by apomorphine in a depressed parkinsonian patient. Movement Disorders 7: 285–287

  • Rego MD, Giller EL. Mania secondary to amantadine treatment of neuroleptic-induced hyperprolactinemia. Journal of Clinical Psychiatry 50: 143–144, 1989

    PubMed  CAS  Google Scholar 

  • Rigby J, Harvey M, Davies DR. Mania precipitated by benzodiazepine withdrawal. Acta Psychiatrica Scandinavica 79: 406–407, 1989

    Article  PubMed  CAS  Google Scholar 

  • Ryback RS, Schwab RS. Manic response to levodopa therapy: report of a case. New England Journal of Medicine 285: 788–789, 1971

    Article  PubMed  CAS  Google Scholar 

  • Sergent JS, Lockshin MD, Klemper MS, Lipsky BA. Central nervous system disease in systemic lupus erythematosus. American Journal of Medicine 58: 644–654, 1975

    Article  PubMed  CAS  Google Scholar 

  • Shulman K, Post F. Bipolar affective disorder in old age. British Journal of Psychiatry 136: 26–32, 1980

    Article  PubMed  CAS  Google Scholar 

  • Spicer CC, Hare EH, Slater E. Neurotic and psychotic forms of depressive illness: evidence from age incidence in a national sample. British Journal of Psychiatry 123: 535–541, 1973

    Article  PubMed  CAS  Google Scholar 

  • Stasiek C, Zetin M. Organic manic disorders. Psychosomatics 26: 394–399, 1985

    Article  PubMed  CAS  Google Scholar 

  • Stone K. Mania in the elderly. British Journal of Psychiatry 155: 220–224, 1989

    Article  PubMed  CAS  Google Scholar 

  • Strahan A, Rosenthal J, Kaswan M, Winston A. Three case reports of acute paroxysmal excitement associated with alprazolam treatment. American Journal of Psychiatry 142: 859–861, 1985

    PubMed  CAS  Google Scholar 

  • Sultzer DL, Cummings JL. Drug-induced mania - causative agents, clinical characteristics and management: a retrospective analysis of the literature. Medical Toxicology and Adverse Drug Experience 4: 127–143, 1989

    PubMed  CAS  Google Scholar 

  • Titus JP. Cimetidine-induced mania in depressed patients. Journal of Clinical Psychiatry 44: 267–268, 1983

    PubMed  CAS  Google Scholar 

  • Turner TH, Cookson JC, Wass JAH, Drury PL, Price PA, et al. Psychotic reactions during treatment of pituitary tumours with dopamine agonists. British Medical Journal 289: 1101–1103, 1984

    Article  PubMed  CAS  Google Scholar 

  • Young RC. Geriatric mania. Clinics in Geriatric Medicine 8: 387–399, 1992

    PubMed  CAS  Google Scholar 

  • van Scheyen JD, van Kammen DP. Clomipramine-induced mania in unipolar depression. Archives of General Psychiatry 36: 560–565, 1979

    Article  PubMed  Google Scholar 

  • Van Woert MH. Ambani LM, Weintraub MI. Manic behavior and levodopa. New England Journal of Medicine 285: 1326–1327, 1971

    Article  Google Scholar 

  • Warren M, Bick PA. Two case reports of trazodone-induced mania. American Journal of Psychiatry 141: 1103–1104, 1984

    PubMed  CAS  Google Scholar 

  • Wehr TA, Goodwin FK. Can antidepressants cause mania and worsen the course of affective illness? American Journal of Psychiatry 144: 1403–1411, 1987

    PubMed  CAS  Google Scholar 

  • Weilburg JB, Sachs G, Falk WE. Triazolam-induced brief episodes of secondary mania in a depressed patient. Journal of Clinical Psychiatry 48: 492–493, 1987

    PubMed  CAS  Google Scholar 

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Ganzini, L., Millar, S.B. & Walsh, J.R. Drug-Induced Mania in the Elderly. Drugs & Aging 3, 428–435 (1993). https://doi.org/10.2165/00002512-199303050-00004

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