Mania Associated with Quetiapine Treatment 2

The use of atypical antipsychotics in treatment of psychiatric diseases is getting more widespread every day. These drugs are called atypical because they provide improvement not only in the positive symptoms, but also in negative symptoms. Also, they have less adverse effects on the extrapyramidal system and tardive dyskinesia, and they do not cause hyperprolactinemia (Stahl 2008). All atypical antipsychotics have higher serotonin type 2 (5HT2) receptor / dopamine type 2 (D2) receptor antagonism rates compared to typical antipsychotics and they are more specific for the mesolimbic system than the stratal dopamine system (Sadock and Sadock 2007). Atypical antipsychotics are indicated for additional or single treatment during the manic period of bipolar disorder, particularly in cases of schizophrenia, as mood regulators, for supplementing antidepressant treatment in cases of both psychotic and non-psychotic depression and for treatment of depressive symptoms in the case of psychosis (Rachid et al 2004, Vieta and Goikolea 2005, Nelson and Papakostas 2009). Quetiapine is a dibenzodiazepine, which has a structure resembling clozapine and quickly separates from the D2 receptors. They are also indicated for persistent depression and anxiety disorders as mood regulators during the manic period of bipolar disorder, the depressive period of bipolar disorder, and bipolar disorders in addition to psychotic disorders (Post and Calabrese 2004, Vieta and Goikolea 2005, Gao et al. 2006, Nelson and Papakostas 2009). The anti-depressive effects of antipsychotic agents beg the question, “do they cause a manic switch?” There are several cases associated with manic/hypomanic switch due to antipsychotics in the literature. However, it was recently suggested that antipsychotics have mood regulating effects and this makes the issue more complex. In this article, a schizophrenic patient with manic symptoms after the administration of quetiapine was discussed in light of the literature.