Does Prozac cause hypomania? (+3 causes)
By
Dr Milena Locci de Oliveira (PhD)
Author bio
Dr Milena Locci de Oliveira is a Pharmacist and Doctor of Philosophy in Sciences from the University of São Paulo (USP). She has experience in microbiology, analytical toxicology, and clinical pharmacokinetics. She writes and reviews content on these topics.
Dr Milena’s Highlights:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration in the areas of Pharmacometrics and Population Pharmacokinetics, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
“Science can be translated, and it is essential that everyone has access to quality information to make informed decisions” – Dr Milena Oliveira, PhD.
Professional Experience:
With a decade-long career as a researcher, Dr Milena has amassed extensive experience in conducting research projects in microbiology, analytical toxicology, and clinical pharmacokinetics.
Her expertise also extends to the preparation of technical and scientific reports, literature reviews, data analysis, and scientific communication, both oral and written.
Dr Milena has served as a Clinical Pharmacist, providing expert supervision and guidance to teams during the challenging times of the COVID-19 pandemic, particularly in the ICUs of two reference hospitals for patient hospitalization.
In her most recent role, Dr Milena worked on the implementation of the deliberatives of the São Paulo State Government Pharmaceutical Assistance Coordination. These decisions were aimed at ensuring medication access within the Unified Health System.
A widely multidisciplinary background enabled Dr Milena to become a professional capable of integrating scientific knowledge into private initiatives, education, and healthcare, delivering consistent services in patient safety and population health.
Professional Memberships & Affiliations:
Dr Milena Oliveira is a member of the Regional Council of Pharmacy of the State of São Paulo, Brazil.
Education:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
Relevant Published Work & Citations:
Oliveira ML de, Rocha A, Nardotto GHB, Pippa LF, Simões BP, Lanchote VL. Analysis of daunorubicin and its metabolite daunorubicinol in plasma and urine with application in the evaluation of total, renal and metabolic formation clearances in patients with acute myeloid leukemia. Journal of Pharmaceutical and Biomedical Analysis. Nov 2020. 191:113-124.
Abstracts. CPT: Pharmacometrics & Systems Pharmacology. 2020 Nov; 9 (S1).
Pippa LF, Oliveira ML de, Rocha A, de Andrade JM, Lanchote VL. Total, renal and hepatic clearances of doxorubicin and formation clearance of doxorubicinol in patients with breast cancer: Estimation of doxorubicin hepatic extraction ratio. Journal of Pharmaceutical and Biomedical Analysis. 2020 Jun 5; 185:113-231.
Godoy ALPC, De Jesus C, De Oliveira ML, Rocha A, Pereira MPM, Larangeira DF, Lanchote VL, Barrouin-Melo SM. Determination of Allopurinol and Oxypurinol in Dogs Plasma by High-Performance Liquid Chromatography with an Ultraviolet Detector: Application for Pharmacokinetic Studies. J Chromatogr Sep Tech. 2017; 8 (4).
Clímaco EC, Oliveira ML de, Pitondo-Silva A, Oliveira MG, Medeiros M, Lincopan N, et al. Clonal complexes 104, 109 and 113 playing a major role in the dissemination of OXA-carbapenemase-producing Acinetobacter baumannii in Southeast Brazil. Infection, Genetics and Evolution. 2013 Oct;19:127–33.
Conference Papers:
Oliveira, M. L.; NARDOTTO, G. H. B.; PIPPA, L. F.; ROCHA, A.; SIMOES, B. P.; LANCHOTE, V. L. . Daunorubicin metabolism and urinary excretion in patients with acute myeloid leukemia. In: 84th Annual Meeting of the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT) and the 20th Annual Meeting of the Association of the Clinical Pharmacology Germany (VKliPha), 2018, Göttingen. Naunyn-Schmiedeberg’s Arch Pharmacol, 2018. v. 391. p. S76-S76.
Oliveira, M. L.; NARDOTTO, G. H. B. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . The low contribution of urinary excretion in the elimination of daunorubicin and its metabolite daunorubicinol in patients with acute myeloid leukemia. In: 49th Brazilian Congress of Pharmacology and Experimental Therapeutics., 2017, Ribeirão Preto. Livro de Resumos, 2017. p. 64-64.
Oliveira, M. L.; PIPPA, L. F. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . Quantification of daunorubicin and its metabolite daunorubicinol in human plasma by LC-MS/MS. In: I International Meeting of Environmental Health and Toxicology (IMEHTOX), 2016, Ribeirão Preto. Livro de Resumos, 2016.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. . PFGE typing of Carbapenem-Resistant Acinetobacter baumannii isolated from different University Hospitals. In: V International Postgraduate and Research Symposium, 2012.
Clímaco, E.C. ; SILVA, A. P. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. Relação clonal entre linhagens de Acinetobacter baumannii produtoras de carbapenemases da família OXA em quatro hospitais no Brasil. In: XXI Latin American Congress of Microbiology, 2012, Santos. XXI Latin American Congress of Microbiology, 2012.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Darini A.L.C. . Dissemintion of OXA carbapenemases genes in carbapenem-resistant Acinetobacter baumannii in University Hospital of Juiz de Fora, MG. In: 8th CIFARP – International Congress of Pharmaceutical Sciences, 2011, Ribeirão Preto.
Clímaco, E.C. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Darini A.L.C. . Avaliação do sequenciamento parcial do gene rpoB e de seus flanqueadores para identificação de espécies de Acinetobacter na rotina laroratorial. In: 2° International Symposium on Clinical Microbiology, 2010, Florianópolis.
You can view some of Dr Milena’s work below and links to her professional profile.
Linkedin: https://www.linkedin.com/in/dra-milena-locci-de-oliveira-28986042/?locale=en_US
ResearchGate: https://www.researchgate.net/profile/Milena-Oliveira-6
Escavador: https://www.escavador.com/sobre/5394254/milena-locci-de-oliveira
Lattes: https://buscatextual.cnpq.br/buscatextual/busca.do
Scopus: https://www.scopus.com/authid/detail.uri?authorId=57199779361
Scholar: https://scholar.google.com/citations?view_op=list_works&hl=pt-BR&user=1YUBDIQAAAAJ
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:
- Talkativeness
- 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.
Cardiovascular complications
Seizures
Sexual disorders
Allergic reactions
Inappropriate levels of the secretion of antidiuretic hormone
Psoriasis
Haematological changes
Conclusion
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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References
1.-
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/
2.-
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
3.-
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
4.-
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
5.-
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
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