Reactions 1401 - 12 May 2012

Escitalopram/clonazepam

Hypomania: 2 case reportsTwo patients developed hypomania while receiving

escitalopram; clonazepam possibly contributed tohypomania in one of the patients [routes not stated].

A 40-year-old woman received escitalopram 10 mg/day,increased to 20 mg/day over 10 days, for recurrentdepressive disorder. Over the next 4 weeks she becameeuthymic; however, after 3 months, she developedhypomania. She received valproate semisodium andolanzapine, and achieved remission within 4 weeks, whichwas maintained at last follow-up.

A 67-year-old man received mirtazapine for depression;however, he did not improve after 15 days, and mirtazapinewas gradually switched to escitalopram 10 mg/day. He alsoreceived clonazepam 0.5 mg/day at bed time to inducesleep. Over 4 weeks, his depressive symptoms resolved.After 3.5 months, he developed hypomania. He receivedquetiapine and valproate semisodium, which controlled hissymptoms, and he was in remission at last follow-up.

Author comment: "In the absence of any past or familyhistory of suicide, depression, bipolar affective disorder ineither case, hypomanic switch appears to be induced byescitalopram in both the cases. Except for a possibility ofboosting the effect of escitalopram by clonazepam . . . in theinduction of hypomania with escitalopram in the secondcase."Sharma RC. Hypomania induced by escitalopram: 2 case reports.Psychopharmacology Bulletin 42: 89-91, No. 2, 1 Jul 2009. Available from: URL:http://www.medworksmedia.com/IssueHome.aspx?id=1 - India 803069801

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