Dose-related Manic Switch with Psychotic Features Following Bupropion Titration: A Case Report

Bupropion is an antidepressant commonly considered to have a relatively low risk of inducing manic switch in the treatment of bipolar depression. However, in certain cases-particularly at higher doses and in the presence of psychotic features-manic switching may occur. In this report, we present a male patient with bipolar I disorder who developed a psychotic manic episode following an increase in bupropion XL dose from 150 mg to 300 mg/day while receiving lithium treatment. This case highlights that, despite its reputation as a relatively safe antidepressant in bipolar depression, bupropion may precipitate dose-related manic and psychotic switches. Based on the clinical findings observed in this patient, cautious dose titration beyond 150 mg/day may be considered in individuals with bipolar disorder with psychotic features, with particular attention to close clinical monitoring following any dose escalation.