[No Title Available]

Abstract

Ziprasidone-induced hypomania Dear Editor, The literature mentions innumerable substances which may induce symptoms of mania and hypomania. Besides antidepressants, which are well described, we should highlight atypical antipsychotics, as they have been used as adjuvants in the treatment of affective disorders. 1-3 Cases of mania and hypomania induced by risperidone and olanzapine have been observed 1 ; however, few and isolated reports are found for ziprasidone. 4,5 A female patient, aged 79 years, had showed a state of discouragement, apathy, irritability and anxiety for five years. She arrived at our service using 60 mg/day of tranylcipromine with partial response. She reported non-treated previous depressive episode, when she was forty years old. She denied having had other physical diseases and was not taking other medications. In admission exams it was diagnosed hypothyroidism and introduced 75µg of levotiroxine. During ambulatory follow-up and after appropriate reposition of thyroid hormones, there was no remission of the symptoms. Thus, we chose to associate 40 mg/day ziprasidone at night. The depressive symptoms remitted in five days and evolved with acceleration of thought, increase of speech and pressure of speech, and mild day somnolence. It was raised the hypothesis of ziprasidone-induced hipomania and the medication was withdrawn, with improvement in the condition in less than one week. The patient was maintained with tranylcipromine and the depressive symptoms have not returned. Mood cycling occurred in close temporal relationship with ziprasidone as soon as it was introduced and remitted after the withdrawal. No other medication was added in that same period. Possible organic causes, such as hypertireoidism caused by excessive hormonal reposition, were ruled out, as there were no significant alterations in routine laboratory tests and recent thyroid function. Of depressed patients, a minority is resistant or intolerant to antidepressants, what makes necessary the use of other resources in the attempt of achieving better responses. The use of atypical antipsychotics has been disseminated as adjuvant in the treatment of mood pictures, both for manic episodes and for depression. 1-3 Ziprasidone is an atypical antipsychotic which has a great antagonist action in the dopamine D2 and serotonin 5-HT2a receptors, having also action on D3, 5-HT2c and 5-HT1d. 2,3 It has an agonist effect in 5-HT1a, besides inhibiting the neuronal reuptake of norepinephrine and serotonin. 2,3 The inducement of manic and hypomanic episodes with atypical antipsychotics is still not well explained; however, it has been proposed that the great affinity for the 5-HT2a receptor, particularly the 5-HT2a/D2 occupation ratio, be responsible for the mood alteration caused by these medications. 1,5 As ziprasidone has a high 5-HT2a/D2 2,5 occupation ratio, increased chances of causing mood cycling is suggested. Controlled clinical trials and naturalistic studies should be performed for a better understanding of these actions, preventing...