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Role of MAOI drugs as triggers of manic episodes in bipolar disorders: A case report and a narrative review

Published online by Cambridge University Press:  01 September 2022

L. Olivier Mayorga ,
L. Ilzarbe ,
H. Andreu Gracia ,
L. Bueno Sanya ,
O. De Juan Viladegut  and
P. Barrio
L. Olivier Mayorga*
Affiliation:
Hospital Clinic de Barcelona, Department Of Psychiatry And Psychology, Institute Of Neuroscience, Barcelona, Spain
L. Ilzarbe
Affiliation:
Hospital Clinic de Barcelona, Department Of Psychiatry And Psychology, Institute Of Neuroscience, Barcelona, Spain
H. Andreu Gracia
Affiliation:
Hospital Clinic de Barcelona, Department Of Psychiatry And Psychology, Institute Of Neuroscience, Barcelona, Spain
L. Bueno Sanya
Affiliation:
Hospital Clinic de Barcelona, Department Of Psychiatry And Psychology, Institute Of Neuroscience, Barcelona, Spain
O. De Juan Viladegut
Affiliation:
Hospital Clinic de Barcelona, Department Of Psychiatry And Psychology, Institute Of Neuroscience, Barcelona, Spain
P. Barrio
Affiliation:
Hospital Clinic de Barcelona, Department Of Psychiatry And Psychology, Institute Of Neuroscience, Barcelona, Spain
*
*Corresponding author.

Abstract

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Introduction

Use of Monoamine Oxidase Inhibitors (MAOIs) has experimented an important reduction in recent years, being replaced by other antidepressant drugs (ADs) associated with a better safety profile. Its use has been restricted to instructed professionals treating resistant and atypical depression. Thus, treatment-emergent affective switch (TEAS) induced by MAOIs is a rare event nowadays.

Objectives

To describe a manic episode associated to a one-year-long treatment with phenelzine, a MAOI agent.

Methods

We present the case of a 47-year-old man hospitalized in our acute psychiatric unit after presenting compatible clinical symptoms with a manic episode. He showed severe irritability, decreased need for sleep, pressured speech, increased energy and goal-directed activities. The patient had started phenelzine a year ago for the treatment of major depressive episode resistant to previous pharmacological essayed treatments. No previous history of TEAS was reported, although he had already taken other ADs and mood-stabilizer treatments in the past.

Results

Several studies reported the effectiveness of MAOIs for the treatment of monopolar depressive episodes resistant to other ADs, especially when atypical symptoms were observed. Data on the use of MAOIs for the treatment of drug-resistant bipolar depressive episodes is scarce. Few studies have described a good response without showing and increased risk of TEAS.

Conclusions

As MAOIs have fallen out of favour with modern psychiatry, there is scarce evidence on the prevalence of TEAS in patients undergoing treatment with these drugs. Further research is needed in order to accurately define these complex relationships.

Disclosure

No significant relationships.

Keywords

treatment-emergent affective switchTEASbipolar disorderMAOI
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S407
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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