Journal of Clinical Toxicology
Open Access

Abstract

Bupropion-Induced Psychotic Mania: Risk Factor, Clinical Course and Dosage

Chih-Ming Cheng and Yuan-Hwa Chou

Bupropion is a dopamine/norepinephrine reuptake inhibitor and considered to carry a much lower risk of inducing mood shift compared with other antidepressants. We described here a patient who experienced the first episode of mania with psychotic features after escalating the dose of bupropion in the treatment of major depression disorder. Miss C is a 40-year-old female, who was diagnosed major depressive disorder with melancholic features and received bupropion 150 mg daily. The dose of bupropion was escalated to 300 mg daily due to the incomplete response. Three days later, she dramatically exhibited elated mood, hostility, irritability, hyper-talkative, hyperactivity, hyper-sexuality, marked delusion of religion, persecution, and grandiosity. The manic symptoms were subsided after discontinuation of bupropion immediately and prescribed quetiapine 300 mg daily within one week. The risk factors for mood shift including iron deficient anemia, melancholic features, clinical course, and the dosage of bupropion is discussed.