Fluvoxamine-associated manic behavior: a case series.

OBJECTIVE

To report cases of manic-like behavior induced by fluvoxamine, a selective serotonin-reuptake inhibitor; to review pertinent literature; and to encourage replication of our findings in larger patient samples.

DESIGN

Description of a case series of fluvoxamine-induced, manic-like behavior.

PATIENTS

Eight patients with depression or obsessive features who developed manic-like behavior after initiation of fluvoxamine therapy.

RESULTS

Manic symptomatology resolved in all eight patients following dosage reduction or withdrawal of fluvoxamine. Four patients still are maintained on low-dose fluvoxamine without recurrent manic symptoms.

CONCLUSIONS

Our case series suggests that fluvoxamine may have the ability to induce or unmask manic behavior in depressed patients. Clinicians are alerted to monitor for this "switching" effect, especially in patients previously or currently treated with neuroleptics or lithium, and in those patients exhibiting characteristics of obsessive-compulsive disorder.