Does Prozac cause hypomania? (+3 causes)
In this article, we will discuss whether Prozac can cause hypomania and what the research suggests about this topic. We will also discuss insights on how to cope with this symptom.
Does Prozac cause hypomania?
Yes, Prozac (fluoxetine) can cause hypomania similar to other SSRIs generally if there are risk factors for bipolar disorder. Contrary to this, few cases have shown that hypomania can also appear in people with no previous history of bipolar disorder. (1,2)
Hypomania is a state where a person is over-active and has high energy levels but it is a toned-down state compared to mania. Prozac is an antidepressant which is not solely responsible for the cause of hypomania in most cases but is triggered due to some underlying state or family history.
Other antidepressants belonging to the class of SSRIs such as paroxetine and sertraline can also result in drug-induced hypomania.
What are the causes of Prozac-induced hypomania?
Some of the causes of Prozac-induced hypomania are listed below: (4)
- Combination of attention-deficit hyperactivity disorder and affective instability
- Family history of affective disorder
- Major depression with psychotic features
- Diagnosis of bipolar disorder
What is the role of SSRIs in hypomanic episodes?
The exact mechanism is unknown and requires more research to be conducted in this field but some studies point towards the serotonergic and catecholamine mechanisms being affected.
One such study states that increased reuptake of serotonin in platelets and the 5-hydroxyindol acetic acid (major metabolite of mania) are the reasons for causing mania. (5)
Prozac-induced hypomania: Case studies
In a chart review study of the efficacy and side effects of fluoxetine, out of 31 hospitalised patients between the age range of 9-18 years, 23% of them experienced hypomania-like symptoms amongst other symptoms such as irritability, insomnia and gastrointestinal upset. (3)
One case study of a 17-year-old boy with tension headaches and mild episodic anxiety symptoms was reported. The patient was given fluoxetine and on following up after 3 weeks the patient reported various symptoms:
- Decreased need for sleep
- Increased activity levels
- Demanding behaviour
This resulted in the diagnosis of fluoxetine-induced hypomania.
In all case reports, fluoxetine was stopped and the hypomanic state came back to normal.
How to manage Prozac-induced hypomania?
Hypomania can be caused as a result of over-dosage. Therefore, reducing or finding the optimal dosing regimen would help manage the condition
More research needs to be conducted to find out what makes an individual more susceptible to hypomania to avoid the administration of Prozac in such individuals.
Stopping the use of Prozac has been shown beneficial in case a patient has developed Prozac-induced hypomania.
What are the common side effects of Prozac?
Prozac-induced hypomania is not considered a common side effect. The list of some of the minor and major side effects have been listed below:
Serotonin syndrome: It can be due to potential overdose or drug interactions. It can be life-threatening. The signs and symptoms include insomnia, agitation, restlessness, confusion, twitching muscles, high blood pressure etc.
Extrapyramidal side effects: This may include dyskinesias, akathisia, parkinsonian-like syndrome, and increased risk of suicide.
Inappropriate levels of the secretion of antidiuretic hormone
In this article, we have discussed that Prozac (fluoxetine) can cause hypomania, which is a milder version of mania, as discussed above. The induction of hypomania is most commonly the result of underlying conditions such as bipolar disorder.
Discontinuation of the medication and trying an alternative can help control the hypomanic state. There is a need for further research in this field to identify the actual mechanism of how Prozac induces the hypomanic state.
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Venkataraman S, Naylor MW, King CA. Mania associated with fluoxetine treatment in adolescents. J Am Acad Child Adolesc Psychiatry. 1992 Mar;31(2):276-81. doi: 10.1097/00004583-199203000-00015. PMID: 1564030. https://pubmed.ncbi.nlm.nih.gov/1564030/
The Journal of Neuropsychiatry and Clinical Neurosciences Volumes 3 Issue 3 (Summer 2011 pages E23-E24) https://neuro.psychiatryonline.org/doi/full/10.1176/jnp.23.3.jnpe23
UMESH JAIN, BORIS BIRMAHER, MANUEL GARCIA, MAYADAH AL-SHABBOUT, and NEAL RYAN. Fluoxetine in Children and Adolescents with Mood Disorders: A Chart Review of Efficacy and Adverse Effects. Journal of Child and Adolescent Psychopharmacology. Jan 1992.259-265. https://www.liebertpub.com/doi/abs/10.1089/cap.1992.2.259
SANJEEV VENKATARAMAN, MICHAEL W. NAYLOR, CHERYL A. KING,
Mania Associated with Fluoxetine Treatment in Adolescents, Journal of the American Academy of Child & Adolescent Psychiatry, Volume 31, Issue 2, 1992, Pages 276-281, ISSN 0890-8567. https://www.sciencedirect.com/science/article/abs/pii/S0890856709644518#:~:text=Apparent%20risk%20factors%20for%20the,affective%20disorder%2C%20especially%20bipolar%20disorder%3B
R. Oğulcan Çiray, Eren Halaç, Serkan Turan, Mustafa Tunçtürk, Mutlu Özbek, Çağatay Ermiş, Selective serotonin reuptake inhibitors and manic switch: A pharmacovigilance and pharmacodynamical study, Asian Journal of Psychiatry, Volume 66, 2021, 102891, ISSN 1876-2018. https://www.sciencedirect.com/science/article/abs/pii/S1876201821003476#preview-section-cited-by