Manic state with carbamazepine therapy of seizures

A 40-year-old man developed an acute state of manic exultation when given carbamazepine for complex partial seizures. The symptoms subsided when carbamazepine was discontinued, but recurred when the drug was inadvertently given again. This observation does not accord with previous evidence of a beneficial psychotropic effect for carbamazepine in some epileptic patients and of some effect in the treatment of mania. Carbamazepine has been shown to have complex actions on multiple neurotransmitter and neuromodulator systems, and it is possible that paradoxical effects of this nature may occur in susceptible individuals, as has been found with other sedative and anticonvulsant agents. The patient recalled brief euphoric periods after seizures, which may suggest that carbamazepine exacerbated or prolonged preexisting cerebral dysfunction.