[Manic state during the addition of lithium in the case of depression resistant to imipramine].

Two women, aged 65 and 43 years, who were suffering from tricyclic-resistant depressions, developed a (hypo)manic state after a few days of lithium addition. In both cases the lithium plasma level was fairly low. For the first woman an increase in the lithium dosage combined with a substitution of the antidepressant resulted in a complete recovery and for the second woman, an increase in the lithium dosage combined with the continued use of the same antidepressant resulted in a recovery to a large extent. In animal experiments lithium addition resulted in a rapid increase in serotonergic neurotransmission, due to an increase in serotonin synthesis and release. This may explain a rapid amelioration of depression as well as the development of (hypo)manic symptoms. Depending on the severity and the persistence of hypomanic symptoms, the antidepressant can be either continued or withdrawn but the lithium dose must be adjusted in order to reach an adequate plasma level of lithium.