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Bipolar disorder, comorbid anxiety disorders, gynecomastia and dental pain: case analysis with literature review

  • Kenneth R. Kaufman (a1), Ronke Babalola (a2), Miriam Campeas (a2) and Melissa Coluccio (a2)

Bipolar disorder with comorbid anxiety disorders frequently requires rational polypharmacy, including use of serotonergic psychotropics. These may result in adverse effects, influencing adherence, complicating treatment and confounding diagnoses. Serotonergic non-adherence is associated with discontinuation syndromes. In this complex case with an on/off/on/off design, both dose-dependent buspirone-induced gynecomastia and buspirone discontinuation syndrome with dental pain are reported. Clinicians and patients should consider these findings to maximise treatment adherence, minimise any unnecessary interventions and address unusual adverse effects. Since patients may not voluntarily disclose specific adverse effects and often do not acknowledge non-adherence, clinician-directed questions are required. This case further emphasises the importance of medication and symptom timelines to guide determination of causation for adverse effects. Although findings from this case cannot be generalised, they suggest the need for continued clinician and patient education, as well as the benefit from detailed case reports.

Declaration of interest


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This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Corresponding author
Correspondence: Kenneth R. Kaufman, Departments of Psychiatry, Neurology, and Anesthesiology, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, Suite #2200, New Brunswick, New Jersey 08901, USA. Email:
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Presented in part at the 19th Annual Conference of the International Society of Bipolar Disorders, Washington DC, May 4–7, 2017.

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Bipolar disorder, comorbid anxiety disorders, gynecomastia and dental pain: case analysis with literature review

  • Kenneth R. Kaufman (a1), Ronke Babalola (a2), Miriam Campeas (a2) and Melissa Coluccio (a2)
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