Case report Alprazolam-induced hypomania

Objective: There are reports of alprazolam-induced hypomanidmania. Here is a case report of a patient who developed hypomania during treatment with alprazolam, but not with diazepam, another benzodiazepine derivative. Clinical picture: The illness was of 2 months ’ duration and the patient received a diagnosis of anxious depression. Following treatment with alprazolam, the patient developed hypomania characterised by euphoria, overactivity, overtalkativity, racing thoughts, oversocialisation, enhanced self-confidence and disturbed sleep. Treatment: Hypomania subsided when alprazolam was withdrawn. There was no recurrence with fluoxetine or diazepam that ameliorated the primary con-dition. Outcome: The patient was symptom-free on follow-up. Conclusions: Alprazolam can induce hypomanidmania and, perhaps, it differs from other benzodiazepines in its mode of action. Clinicians have to be alert to the possibility of their patients developing hypomanidmania while on alpra-zolam. Australian and New Zealand Journal of Psychiatry 1996; 30:550-552 Alprazolam, a triazolobenzodiazepine, is useful in treating panic disorder [ 1-31 and generalised anxiety disorder [4-61. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOs) are reported to induce mania in depressed subjects [7]. There are also a growing number of reports of hypomanicl manic symptomatology developing during alprazo-lam treatment. In all, 13 cases of alprazolam-induced switch to hypomanidmania have been published [8]. Seven of the patients had diagnoses of panic disorder or panic with agoraphobia. One of these patients had a past history of depression and the other had comor-bid depression. Of the other six patients who pre-sented with depression, two had bipolar depression, one had a past history of alprazolam-induced hypo