Varenicline-induced Manic Episode in a Bipolar I Disorder Patient

Abstract

Objective: Since varenicline was approved for smoking cessation in 2006, but case reports associated with psychiatric adverse effects have been published, especially with regard to depression, but not manic episodes. Case report: We describe a 52-year-old ethnic Taiwanese male with a history of bipolar I disorder. He had received regular treatment in the clinic and psychiatric nursing home for one and half years. He developed mixed mood and psychotic disturbances after an eight-day varenicline treatment. After withdrawal of varenicline treatment 15 days, his mood stabilized. He was discharged 23 days later and received regular clinical follow-up. Conclusion: This case, history suggests that preventive measures with closed observation are needed if a bipolar patient quits smoking with varenicline. Further study should be identified that varenicline-induced manic episode is due to imbalance between cholinergic, adrenergic or dopaminergic tone.