Atomoxetine Induced Hypomania in a Patient with Bipolar Disorder and Adult Attention Deficit Hyperactivity Disorder

Abstract

Comorbidity of bipolar disorder (BD) with attention deficit hyperactivity disorder (ADHD) is frequent. The management of comorbid ADHD and BD is complicated by the risk of induction of (hypo) mania by the medications used for ADHD treatment. Earlier reports in children and adolescents with ADHD-BD suggest that the possibility of (hypo) mania induction is low when atomoxetine is used along mood stabilizers or antipsychotics. Here, we report induction of hypomania by atomoxetine when used for the treatment of comorbid ADHD in a BD patient while on prophylactic treatment with mood stabilizers. This report indicates that atomoxetine carries the risk of induction of (hypo) mania even in stabilized BD patients. Clinicians should closely monitor such patients for (hypo) mania symptoms.

Atomoxetine Associated Activation Syndrome in Adolescent Patients With ADHD

“…The most typical side effects of atomoxetine in children with ADHD include gastrointestinal problems, somnolence, cardiovascular adverse reactions, and various other nonspecific symptoms (irritability, light-headedness, tiredness, headache) 1 . It has been documented that in children and adolescents without a history of psychosis or mania, atomoxetine at recommended dosages may be linked to treatment-emergent psychotic or manic symptoms or worsening of preexisting manic/psychotic symptoms 4–6 . As of February 2024, we found one case report in our literature search of an adolescent boy diagnosed with ADHD with activation syndrome following atomoxetine therapy.…”

“…1 It has been documented that in children and adolescents without a history of psychosis or mania, atomoxetine at recommended dosages may be linked to treatment-emergent psychotic or manic symptoms or worsening of preexisting manic/psychotic symptoms. [4][5][6] As of February 2024, we found one case report in our literature search of an adolescent boy diagnosed with ADHD with activation syndrome following atomoxetine therapy. The authors recommended that the symptoms should be differentiated from mania/ hypomania.…”

ADHD and Bipolar Disorder in Adulthood: Clinical and Treatment Implications

“…However, five case reports described hypomanic or manic switches with atomoxetine. [ 75 , 76 , 77 , 78 , 79 ] Therefore, precautionarily, both the European summary of product characteristics and the US label state that treatment-emergent mania “without a prior history of psychotic illness or mania can be caused by atomoxetine at usual doses” [ 80 ].…”