Download PDF
Pharmacopsychiatry 2011; 44(2): 78-81
DOI: 10.1055/s-0030-1268428
Letter

© Georg Thieme Verlag KG Stuttgart · New York

Three Cases of Hypomania and One Case of Mania During Aripiprazole Treatment

M. Viikki1 , 2 , H. M. Valtonen3 , 4 , E. Leinonen1 , 5
  • 1University of Tampere, Medical School, University of Tampere, Finland
  • 2Tampere Mental Health Centre, Tampere, Finland
  • 3Department of Mental Health and Substance Use, National Institute for Health and Welfare, Helsinki, Finland
  • 4Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
  • 5Tampere University Hospital, Department of Psychiatry, Tampere, Finland
Further Information

Publication History

received 24.06.2010 revised 18.10.2010

accepted 19.10.2010

Publication Date:
14 December 2010 (online)

Also available at
    Permissions and Reprints

Atypical antipsychotics, like aripiprazole, can induce reversible mood elevation. We report 3 cases of hypomania and 1 mania during low doses of aripiprazole treatment. In 2 patients diagnosed with bipolar II, aripiprazole was used for the treatment of depressive episodes and in 1 patient it was used as an adjunct agent in treatment-resistant unipolar depression. Mania was induced in the bipolar I patient during treatment for a mixed episode. All cases are highly suggestive of a causal relationship between aripiprazole and hypomania/mania. The antipsychotic action of aripiprazole has been suggested to show an inverted U-shaped dose-response; in smaller aripiprazole doses (<15 mg) it more often acts as a partial agonist, whereas in higher doses more often as an antagonist. It may therefore be more likely to induce hypomania/mania in smaller doses. Our cases support this hypothesis.

References

  • 1 Akiskal HS, Hantouche EG, Allilaire JF. et al . Validating antidepressant-associated hypomania (bipolar III): a systematic comparison with spontaneous hypomania (bipolar II).  J Affect Disord. 2003;  73 65-74
    CrossrefPubMedGoogle Scholar
  • 2 Atmaca M, Kuloglu M, Buyukbayram A. et al . Quetiapine-associated and dose-related hypomania in a woman with schizophrenia.  Eur Psychiatry. 2002;  17 292-293
    CrossrefPubMedGoogle Scholar
  • 3 Aubry JM, Simon AE, Bertschy G. Possible induction of mania and hypomania by olanzapine or risperidone: a critical review of reported cases.  J Clin Psychiatry. 2000;  61 649-655
    CrossrefPubMedGoogle Scholar
  • 4 Berman RM, Marcus RN, Swanink R. et al . The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study.  J Clin Psychiatry. 2007;  68 843-853
    CrossrefPubMedGoogle Scholar
  • 5 Burris KD, Molski TF, Xu C. et al . Aripiprazole, a novel antipsychotic, is a high-affinity partial agonist at human dopamine D2 receptors.  J Pharmacol Exp Ther. 2002;  302 381-389
    CrossrefPubMedGoogle Scholar
  • 6 Davis R, Risch SC. Ziprasidone induction of hypomania in depression?.  Am J Psychiatry. 2002;  159 673-674
    CrossrefPubMedGoogle Scholar
  • 7 Diaz SF. Mania associated with risperidone use.  J Clin Psychiatry. 1996;  57 41-42
    PubMedGoogle Scholar
  • 8 Donohue A. First manic episode in a 55-year-old man after initiation of aripiprazole.  Psychiatry (Edgmont). 2010;  7 37-39
    PubMedGoogle Scholar
  • 9 Faedda GL, Tondo L, Baldessarini RJ. et al . Outcome after rapid vs. gradual discontinuation of lithium treatment in bipolar disorders.  Arch Gen Psychiatry. 1993;  50 448-455
    CrossrefPubMedGoogle Scholar
  • 10 Fitz-Gerald MJ, Pinkofsky HB, Brannon G. et al . Olanzapine-induced mania.  Am J Psychiatry. 1999;  156 1114
    PubMedGoogle Scholar
  • 11 Henry C, Demotes-Mainard J. Olanzapine-induced mania in bipolar disorders.  J Psychiatry Neurosci. 2002;  27 200-201
    PubMedGoogle Scholar
  • 12 Jordan S, Koprivica V, Chen R. et al . The antipsychotic aripiprazole is a potent, partial agonist at the human 5-HT1A receptor.  Eur J Pharmacol. 2002;  441 137-140
    CrossrefPubMedGoogle Scholar
  • 13 Kane JM, Fleischhacker WW, Hansen L. et al . Akathisia: an updated review focusing on second-generation antipsychotics.  J Clin Psychiatry. 2009;  70 627-643
    CrossrefPubMedGoogle Scholar
  • 14 Keating AM, Aoun SL, Dean CE. Ziprasidone-associated mania: a review and report of 2 additional cases.  Clin Neuropharmacol. 2005;  28 83-86
    CrossrefPubMedGoogle Scholar
  • 15 Lykouras L, Oulis P, Hatzimanolis J. Manic symptoms associated with quetiapine treatment.  Eur Neuropsychopharmacol. 2003;  13 135-136
    CrossrefPubMedGoogle Scholar
  • 16 Marcus RN, McQuade RD, Carson WH. et al . The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a second multicenter, randomized, double-blind, placebo-controlled study.  J Clin Psychopharmacol. 2008;  28 156-165
    CrossrefPubMedGoogle Scholar
  • 17 McDaniel JS, Ninan PT, Magnuson JV. Possible induction of mania by buspirone.  Am J Psychiatry. 1990;  147 125-126
    PubMedGoogle Scholar
  • 18 Padala PR, Wengel SP, Petty F. Manic episode during treatment with aripiprazole.  Am J Psychiatry. 2007;  164 172-173
    PubMedGoogle Scholar
  • 19 Rachid F, Bertschy G, Bondolfi G. et al . Possible induction of mania or hypomania by atypical antipsychotics: an updated review of reported cases.  J Clin Psychiatry. 2004;  65 1537-1545
    CrossrefPubMedGoogle Scholar
  • 20 Stahl SM. Do dopamine partial agonists have partial efficacy as antipsychotics?.  CNS Spectr. 2008;  13 279-282
    PubMedGoogle Scholar
  • 21 Stark AD, Jordan S, Allers KA. et al . Interaction of the novel antipsychotic aripiprazole with 5-HT1A and 5-HT2A receptors: functional receptor-binding and in vivo electrophysiological studies.  Psychopharmacology (Berl). 2007;  190 373-382
    CrossrefPubMedGoogle Scholar
  • 22 Thase ME, Jonas A, Khan A. et al . Aripiprazole monotherapy in nonpsychotic bipolar I depression: results of 2 randomized, placebo-controlled studies.  J Clin Psychopharmacol. 2008;  28 13-20
    CrossrefPubMedGoogle Scholar
  • 23 Tomlinson WC. Rispiridone and mania.  Am J Psychiatry. 1996;  153 132-133
    PubMedGoogle Scholar
  • 24 Traber R, Schneiter R, Modestin J. A case of aripiprazole-induced mania.  Pharmacopsychiatry. 2007;  40 37-38
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Zahodne LB, Fernandez HH. Pathophysiology and treatment of psychosis in Parkinson's disease: a review.  Drugs Aging. 2008;  25 665-682
    CrossrefPubMedGoogle Scholar

Correspondence

M. ViikkiMD, PhD 

University of Tampere

Medical School

33014 University of Tampere

Finland

Phone: +358/50/339 6646

Fax: +358/3/3551 6164

Email: merja.viikki@gmail.com