Mania/Hypomania induced by quetiapine: A case report and review of literature

We report a case of 26 years old gentleman diagnosed with bipolar affective disorder who developed mania after one week of initiation of quetiapine at 200mg/d. Induction of mania in our patient is keeping with the literature regarding induction or worsening of hypomanic or manic symptoms at a lower dose of quetiapine. Hypomanic or manic symptoms at a low dose of quetiapine are brief and seem to reverse the effect by either discontinuing the causing agent or increasing it dose. Quetiapine being an atypical antipsychotic possess antidepressant property at low doses as well as mood stabilizer at higher doses. At lower dose, due to its serotonergic antagonism property, quetiapine appears to induce or worsen hypomanic or manic symptoms. As the dosage increases its dopamine antagonistic activity become more prominent and the medication acts as a mood stabilizer. This is one of the possible explanations of disappearing of manic or hypomanic symptoms at a higher dose.