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

¹ Mobile Psychiatric Unit of the Prefectures of Ioannina and Thesprotia, Greece.
² Department of Pharmacology, Medical School, University of Ioannina, Ioannina, Greece.
³ Mobile Psychiatric Unit of the Prefectures of Ioannina and Thesprotia, Greece.; Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.
⁴ Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.

^* To whom correspondence should be addressed.

	Abstract

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 the 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

First published on June 18, 2008, doi:10.1177/0269881108089841

Journal of Psychopharmacology 2009;23:592.

A more recent version of this article appeared on July 1, 2009


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