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Duloxetine-induced hypomania: case report and brief review of the literature on SNRIs-induced mood switching

Mobile Psychiatric Unit of the Prefectures of Ioannina and Thesprotia, Greece. vaios.peritogiannis{at}medai.gr

K Antoniou

Department of Pharmacology, Medical School, University of Ioannina, Ioannina, Greece.

V Mouka

Mobile Psychiatric Unit of the Prefectures of Ioannina and Thesprotia, Greece;; Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.

V Mavreas

Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.

TN Hyphantis

Mobile Psychiatric Unit of the Prefectures of Ioannina and Thesprotia, Greece.

Abstract

Manic switching during antidepressant treatment has been reported with every class of antidepressant drugs. Serotonin-noradrenaline reuptake inhibitors (SNRIs) have been increasingly used for the treatment of unipolar and bipolar depression and are well tolerated and sufficiently effective because of their dual mechanism of action. A case of duloxetine-induced hypomania in a non-bipolar patient is presented, and a brief review of all cases of SNRIs’ induced mania and hypomania has been carried out. The available data suggest that SNRIs, especially venlafaxine, can induce mood switching in patients with bipolar depression and in certain patients with unipolar depression, but the potential of duloxetine and milnacipran to induce manic or hypomanic symptoms cannot be disregarded. Switching appears to be dose-related and treatment initiation with lower doses and upward titration when needed may be preferable in selected cases and may help minimizing the risk of mood switching.

Key Words: duloxetine • hypomania • mania • serotonin-noradrenaline reuptake inhibitors • switching • venlafaxine

This version was published on July 1, 2009

Journal of Psychopharmacology, Vol. 23, No. 5, 592-596 (2009)
DOI: 10.1177/0269881108089841


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