Three Cases of Hypomania and One Case of Mania During Aripiprazole Treatment

Atypical antipsychotics, like aripiprazole, can induce reversible mood elevation. We report 3 cases of hypomania and 1 mania during low doses of aripiprazole treatment. In 2 patients diagnosed with bipolar II, aripiprazole was used for the treatment of depressive episodes and in 1 patient it was used as an adjunct agent in treatment-resistant unipolar depression. Mania was induced in the bipolar I patient during treatment for a mixed episode. All cases are highly suggestive of a causal relationship between aripiprazole and hypomania/mania. The antipsychotic action of aripiprazole has been suggested to show an inverted U-shaped dose-response; in smaller aripiprazole doses (<15 mg) it more often acts as a partial agonist, whereas in higher doses more often as an antagonist. It may therefore be more likely to induce hypomania/mania in smaller doses. Our cases support this hypothesis.