Hypomanic episode secondary to treatment with clarithromycin in an adolescent patient

Abstract

Bipolar disorder is a chronic brain disorder characterized by episodes of extreme changes and alterations in mood, energy, thinking and behavior. Researchers have identified cases of bipolar disorder in all age groups studied, including preschoolers. The existence of Bipolar Disorder in children and adolescents has been a controversial issue throughout the history of child psychiatry and there is few data on the natural course and long-term outcome of early-onset bipolar disorder, especially in the pre-pubescent age.

Manic episodes are defined as states of joy or excitement not consistent with the circumstances of the individual and range from increased animation (hypo mania) to an almost uncontrollable violent excitement. Although overall mania is associated with bipolar disorder, it is important to note that manic episodes may be secondary to metabolic or neurological disorders or the manifestation of an adverse reaction to a drug. Among the drugs which could cause the occurrence of episodes of mania and hypomania are: dopaminergic antiparkinsonian, sympathomimetic drugs, antidepressants, anticholinergics, steroids and antibiotics. We reported the case of sixteen year old boy who entered the hospital for a hypomanic episode maniform onset of symptoms within days of starting treatment with clarithromycin for acne problem.

Through this case, we review in pubmed of reported cases in the general population symptoms secondary to treatment with macrolides, particularly clarithromycin. We also note the symptoms of this disorder, special features in this age group and risk factors that may favor the development.