Manic Episode Associated With Clarithromycin in a Patient With Medically Treated Depression
Bibliographic record
Abstract
To the Editor: Antibiotic-induced mania, or antibiomania, is an uncommon cause of manic episodes.1 Clarithromycin is one of the most frequently implicated antibiotics.1 Here, a case of clarithromycin-associated mania in a patient with medically treated depression is presented. Case report. Mr A, a 53-year-old schoolteacher with a history of depression, developed increasing distractibility while driving on the highway in 2011, elevating to the point at which he had to stop driving. The patient believed he was having a stroke and presented himself to the emergency department. On examination, the patient displayed agitation, pressured and tangential speech, flight of ideas, distractibility, grandiosity, and disorganized behavior. He became increasingly agitated and a “code white” was called; as a result, the patient was restrained and given haloperidol and lorazepam intramuscularly, which calmed him down. Medical workup was negative for another cause of mania. Mr A had been taking oral citalopram 20 mg daily for the last 15 years to treat his depression. He was also taking oral clarithromycin 1,000 mg daily, which had been prescribed for sinusitis 5 days prior to presentation. The patient noted elevated mood, increased pleasure in his job, and requiring less sleep 1 day after starting clarithromycin. The patient was admitted, and clarithromycin and citalopram were discontinued. Three days later, Mr A’s condition was stable, and he had few manic symptoms. He was started on olanzapine, 10 mg at bedtime, and lamotrigine, which was titrated to 50 mg twice daily. The patient was discharged 10 days after admission. Nightingale et al2 described the first cases of clarithromycin-induced mania in 1995 in 2 patients with AIDS who were prescribed clarithromycin to treat a Mycobacterium avium complex infection. About a year later, in 1996, Cone et al3 described the first case of clarithromycin-induced mania in a patient without AIDS who was prescribed clarithromycin for a soft-tissue infection. Four other cases of clarithromycin-induced mania have since been described in which clarithromycin was prescribed for sinusitis or H pylori infection.4–7 In all cases, mania resolved with discontinuation of clarithromycin.2–7 In only 1 case did the patient have a history of depression.5 The mechanism for antibiotic-induced mania is currently unknown, although several theories have been proposed, including raised serum concentration of the antibiotic (leading to higher central nervous system penetration), antibiotic interactions with neurotransmitters, and antibiotic interactions with cortisol and prostaglandins.1 Management of antibiotic-induced mania typically involves discontinuation of the antibiotic and possible addition of mood-stabilizing medications.1,7 In this case, manic symptoms began to subside with discontinuation of clarithromycin. It is not clear whether clarithromycin is the direct cause of the manic episode, but it could be a contributing trigger. However, due to the past history of depression, the high degree of mania, and the occurrence during driving, mood-stabilizing medications were prescribed. Clarithromycin-induced mania is not a common occurrence, but consideration of this phenomenon could be useful in the differential diagnosis of an episode of mania.7
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".