Isoniazid-induced mania and the history of antidepressant drugs: Case report and literature review.

Abstract

Isoniazid is the first-line antimicrobial drug for the treatment of Tuberculosis, a leading cause of death worldwide. In rare but likely under-reported cases, isoniazid is associated with the emergence of secondary manic and/or psychotic symptoms. We report a case of secondary mania following 1 month of isoniazid preventive therapy and summarize the results of a literature review on this topic. We describe the case of a 46-year-old Portuguese male with a history of ankylosing spondylitis, who started isoniazid preventive therapy for latent tuberculosis a month prior to his involuntarily hospitalization due to manic and psychotic symptoms. The symptoms resolved after the discontinuation of isoniazid and the introduction of olanzapine and sodium valproate. There was no recurrence of manic and psychotic symptoms in a 6-month follow-up period and an isoniazid-induced mania diagnosis was assumed. The association between isoniazid and neuropsychiatric adverse effects, such as mania and psychotic symptoms, has been reported in the scientific literature. Although rare, these adverse effects should be taken into account and an immediate withdrawal of isoniazid is required. In some cases, specialized psychiatric evaluation treatment is also necessary. Isoniazid's manic adverse effects led to the development of MAO inhibitors, the first class of antidepressant drugs, and to the understanding of a neurobiological basis for psychiatric conditions. Considering the high TB incidence worldwide and isoniazid's use as the first-line antimicrobial treatment, physicians must be aware of its serious but reversible adverse neuropsychiatric reactions and how to approach them.