Tramadol-associated mania: A case report

Jamaluddin Nimah, MD; Alexander Chen, BA; Kelly N. Gable, PharmD, BCPP; Alan R. Felthous, MD

doi:10.5055/jom.2017.0386

Authors

Jamaluddin Nimah, MD
Alexander Chen, BA
Kelly N. Gable, PharmD, BCPP
Alan R. Felthous, MD

DOI:

https://doi.org/10.5055/jom.2017.0386

Keywords:

tramadol, bipolar disorder, mania, adverse drug effects

Abstract

A variety of medications, most notably tricyclic antidepressants, and other antidepressants including venlafaxine have been reported to have triggered manic episodes in patients with bipolar disorder. The synthetic opioid tramadol has also been associated with mania activation. This report describes an unusual case of tramadol-associated mania in a patient without a charted diagnosis of bipolar disorder. However, she had a history of two prior episodes of mania following administration of tramadol that were also believed to be related to medication-induced mood disorder rather than underlying bipolar disorder. We hypothesize that tramadol-associated mania may have an underlying mechanism involving monoamine neurotransmission and increased oxidative stress.

Author Biographies

Jamaluddin Nimah, MD

Department of Medicine, University of California at Los Angeles, Los Angeles, California

Alexander Chen, BA

Department of Psychiatry, School of Medicine, Saint Louis University, St. Louis, Missouri

Kelly N. Gable, PharmD, BCPP

School of Pharmacy, Southern Illinois University at Edwardsville, Edwardsville, Illinois

Alan R. Felthous, MD

Forensic Psychiatry Division, Department of Psychiatry, School of Medicine, Saint Louis University, St. Louis, Missouri.

References

Rachid F, Gilles B, Bondolfi G, et al.: Possible induction of mania or hypomania by atypical antipsychotics: An updated review of reported cases. J Clin Psychiatry. 2004; 65: 1537-1545.

Saatcioglu O, Erim R, Nesrin T, et al.: Antidepressant-associated maniaor hypomania: A comparison with personality and bipolarity features of bipolar disorder. J Affective Disorders. 2011; 134: 85-90.

Schaffer CB, Nordahl TE, Schaffer LC, et al.: Mood-elevating effects of opioid analgesics in patients with bipolar disorder. J Neuropsychiatry Clin Neurosci. 2007; 19(4): 449-452.

Watts B, Grady T: Tramadol-induced mania. Am J Psychiatry. 1997; 154: 1624.

Oronsky BT, Martin R: Intolerance to tramadol may herald bipolar disease. Internet J Family Practice. 2008; 6(2): 4.

Yaksh TL, Wallace MS: Opioids, analgesia and pain management. In Brunton LL, Chabner BA, Knollmann BC (eds.): Goodman & Gilman's Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw Hill Medical, 2011: 481-564.

Lewis KS, Han NH: Tramadol. A new centrally acting analgesic. Am J Health Syst Pharm. 1997; 54: 643-652.

Frink MC, Hennies HH, Englberger W, et al.: Influence of tramadol on neurotransmitter systems of the rat brain. Arzneimittelforschung. 1996; 46(11): 1029-1036.

Reimann W, Schneider F: Induction of 5-hydroxytryptamine release by tramadol, fenfluramine and reserpine. Eur J Pharmacol. 1998; 349(2-3): 199-203.

Rao JS, Harry GJ, Rapoport SI, et al.: Increased excitotoxicity and neuroinflammatory markers in postmortem frontal cortex from bipolar disorder patients. Mol Psychiatry. 2010; 15(4): 384-392.

Post RM, Jimerson DC, Bunney WE Jr, et al.: Dopamine and mania: Behavioral and biochemical effects of the dopamine receptor blocker pimozide. Psychopharmacology. 1980; 67(3): 297-305.

Bunney WE Jr, Garland-Bunney BL: Mechanisms of action of lithium in affective illness: Basic and clinical implications. In Meltzer HY (ed.) Psychopharmacology: The Third Generation of Progress. New York: Raven Press, 1987: 553-565.

Redmond DE Jr, Katz MM, Maas JW, et al.: Cerebrospinal fluid amine metabolites. Relationships with behavioral measurements in depressed, manic, and healthy control subjects. Arch Gen Psychiatry. 1986; 43(10): 938-947.

Tolmunen T, Joensuu M, Saarinen PI, et al.: Elevated midbrain serotonin transporter availability in mixed mania: A case report. BMC Psychiatry. 2004; 4: 27.

Vial D, Piomelli D: Dopamine D2 receptors potentiate arachidonate release via activation of cytosolic, arachidonate-specific phospholipase A2. J Neurochem. 1995; 64(6): 2765-2772.

Felder CC, Kanterman RY, Ma AL, et al.: Serotonin stimulates phospholipase A2 and the release of arachidonic acid in hippocampal neurons by a type 2 serotonin receptor that is independent of inositolphospholipid hydrolysis. Proc Natl Acad Sci USA. 1990; 87(6): 2187-2191.

Pavoine C, Magne S, Sauvadet A, et al.: Evidence for a beta2-adrenergic/arachidonic acid pathway in ventricular cardiomyocytes. Regulation by the beta1-adrenergic/camp pathway. J Biol Chem. 1999; 274(2): 628-637.

Basselin M, Chang L, Bell JM, et al.: Chronic lithium chloride administration attenuates brain NMDA receptor-initiated signaling via arachidonic acid in unanesthetized rats. Neuropsychopharmacology. 2006; 31(8): 1659-1674.

Lüschen S, Adam D, Ussat S, et al.: Activation of ERK1/2 and cPLA(2) by the p55 TNF receptor occurs independently of FAN. Biochem Biophys Res Commun. 2000; 274(2): 506-512.

Dinarello CA: Interleukin-1. Ann N Y Acad Sci. 1988; 546: 122-132.

Jope RS, Roh M: Glycogen Synthase Kinase-3 (GSK3) in Psychiatric Diseases and Therapeutic Interventions. Curr Drug Targets. 2006; 7(11): 1421-1434.

Sobczak S, Honig A, Christophe A, et al.: Lower high-density lipoprotein cholesterol and increased omega-6 polyunsaturated fatty acids in first-degree relatives of bipolar patients. Psychol Med. 2004; 34(1): 103-112.

Jope RS, Johnson GV: The glamour and gloom of glycogen synthase kinase-3. Trends Biochem Sci. 2004; 29(2): 95-102.

Kim HW, Rapoport SI, Rao JS: Altered expression of apoptotic factors and synaptic markers in postmortem brain from bipolar disorder patients. Neurobiol Dis. 2010; 37(3): 596-603.

Coyle TR, Kochunov P, Patel RD, et al.: Cortical sulci and bipolar disorder. Neuroreport. 2006; 17(6): 1739-1742.

Lyoo IK, Sung YH, Dager SR, et al.: Regional cerebral cortical thinning in bipolar disorder. Bipolar Disord. 2006; 8(1): 65-74.

Strakowski SM, DelBello MP, Zimmerman ME, et al.: Ventricular and periventricular structural volumes in first- versus multiple-episode bipolar disorder. Am J Psychiatry. 2002; 159(11): 1841-1847.

Osuji IJ, Cullum CM: Cognition in bipolar disorder. Pyschiatr Clin North Am. 2005; 28(2): 427-441.

Ghoneim FM, Khalaf HA, Elsamanoudy AZ, et al.: Effect of chronic usage of tramadol on motor cerebral cortex and testicular tissues of adult male albino rats and the effect of its withdrawal: Histological, immunohistochemical and biochemical study. Int J Clin Exp Pathol. 2014; 7(11): 7323-7341.

Wehr TA, Goodwin FK: Can antidepressants cause mania and worsen the course of affective illness? Am J Psychiatry. 1987; 144(11): 1403-1411.

Bunney WE Jr, Murphy DL, Goodwin FK, et al.: The switch process from depression to mania: relationship to drugs which alter brain amines. Lancet. 1970; 1(7655): 1022-1027.

Bunney WE Jr, Goodwin FK, Murphy DL, et al.: The “switch process” in manic-depressive illness. II. Relationship to catecholamines, REM sleep, and drugs. Arch Gen Psychiatry. 1972; 27(3): 304-309.

Mundo E, Walker M, Cate T, et al.: The role of serotonin transporter protein gene in antidepressant-induced mania in bipolar disorder: Preliminary findings. Arch Gen Psychiatry. 2001; 58(6): 539-544.

Nemeroff CB, Evans DL, Gyulai L, et al.: Double-blind, placebo-controlled comparison of imipramine and paroxetine in the treatment of bipolar depression. Am J Psychiatry. 2001; 158(6): 906-912.

Cohn JB, Collins G, Ashbrook E, et al.: A comparison of fluoxetine imipramine and placebo in patients with bipolar depressive disorder. Int Clin Psychopharmacol. 1989; 4(4): 313-322.

Himmelhoch JM, Thase ME, Mallinger AG, et al.: Tranylcypromine versus imipramine in anergic bipolar depression. Am J Psychiatry. 1991; 148(7): 910-916.

Vieta E, Martinez-Aran A, Goikolea JM, et al.: A randomized trial comparing paroxetine and venlafaxine in the treatment of bipolar depressed patients taking mood stabilizers. J Clin Psychiatry. 2002; 63(6): 508-512.

Beaulieu JM, Sotnikova TD, Yao WD, et al.: Lithium antagonizes dopamine-dependent behaviors mediated by an AKT/glycogen synthase kinase 3 signaling cascade. Proc Natl Acad Sci USA. 2004; 101(14): 5099-5104.

Viktorin A, Lichtenstein P, Thase ME, et al.: The risk of switch to mania in patients with bipolar disorder during treatment with an antidepressant alone and in combination with a mood stabilizer. Am J Psychiatry. 2014; 171(10): 1067-1073.

Ketter TA, Chang KD: Bipolar and related disorders. In Hales RE, Yudofsky SC, Weiss L (eds.): Textbook of Psychiatry. 6th ed. Washington, DC: American Psychiatric Publishing, 2014: pp. 311-352.

Rellinf MV, Giacomini KM: Pharmacogenetics. In Brunton LL, Chabner BA, Knollmann BC (eds.): Goodman and Gilman's Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw Hill Medical, 2011: pp. 145-168.