Evolving mania in an adolescent treated with low-dose fluoxetine

Area of Science:

• Child and Adolescent Psychiatry
• Pharmacopsychiatry
• Neurodevelopmental Disorders

Background:

• Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine are commonly prescribed for Attention-Deficit Hyperactivity Disorder (ADHD) and conduct disorder.
• Antidepressant-induced mania is a recognized phenomenon, but its occurrence in pediatric patients with comorbid neurodevelopmental disorders requires careful consideration.

Purpose of the Study:

• To report a case of fluoxetine-induced mania in a pediatric patient with ADHD and conduct disorder.
• To emphasize the importance of monitoring for mood switching during SSRI treatment in this population.

Main Methods:

• A case study of a 13-year-old male with ADHD and conduct disorder who developed manic symptoms.
• Medication trials including methylphenidate, fluoxetine, lithium, and carbamazepine were documented.
• Diagnostic criteria (DSM-III-R) for nonpsychotic mania were applied.

Main Results:

• The patient developed clear-cut manic symptoms after 2 days on fluoxetine 20 mg daily.
• Manic symptoms persisted after fluoxetine discontinuation but were controlled by lithium and carbamazepine.
• Hypomanic or manic symptoms appeared to emerge during the second week of fluoxetine treatment at 10 mg daily.

Conclusions:

• Fluoxetine can induce manic episodes in children and adolescents with ADHD and conduct disorder, even at low doses.
• Clinicians should be vigilant for the possibility of a manic switch during fluoxetine treatment in this patient group.
• Mood stabilizers may be necessary to manage antidepressant-induced mania in pediatric patients.