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Letters   |    
Repetitive Transcranial Magnetic Stimulation or Venlafaxine-Induced Mania?
Samir Kumar Praharaj, M.D., D.P.M.
The Journal of Neuropsychiatry and Clinical Neurosciences 2011;23:E17-E17.

To the Editor: In a recent issue of your journal, Chang et al.1 reported aa manic episode in a 45-year-old man after a combined treatment of repetitive transcranial magnetic stimulation (rTMS) and venlafaxine. His manic symptoms were observed 4 weeks after the last rTMS session, while he was on venlafaxine 150 mg/day. Rapid rTMS applied over the left prefrontal cortex not only has antidepressant effect, but has been reported to produce manic switches.2 In these case studies, manic or hypomanic switch appeared as early as the first session after starting rTMS or few days (maximum of 1 week) after rTMS treatment.2 Further analysis of data revealed that treatment-emergent mania or hypomania occurred at a rate of 0.84% in the active rTMS treatment group, which was not significantly different from the sham group (0.73%).2 Also, in a recent case study,3 hypomanic switch with transcranial DC stimulation occurred during treatment, after the third session.

Venlafaxine has been reported to induce mood-switching in patients with bipolar depression and in a few with unipolar depression.4 It is interesting to note that the time period from the introduction or the dose increment of venlafaxine to the induction of the manic or hypomanic episode ranged from 6 days to several weeks.4 Therefore, it is likely that the switch in the Chang et al.1 case was due to venlafaxine, rather than rTMS treatment.

Chang  CH;  Chen  SJ;  Chang  CH  et al:  Manic episode following a combined treatment of repetitive transcranial magnetic stimulation and venlafaxine.  J Neuropsychiatry Clin Neurosci 2010; 22:E18, E19
[PubMed]
[CrossRef]
 
Xia  G;  Gajwani  P;  Muzina  DJ  et al:  Treatment-emergent mania in unipolar and bipolar depression: focus on repetitive transcranial magnetic stimulation.  Int J Neuropsychopharmacol 2008; 11:119–130
[PubMed]
[CrossRef]
 
Arul-Anandam  AP;  Loo  C;  Mitchell  P:  Induction of hypomanic episode with transcranial direct current stimulation.  J ECT 2010; 26:68–69
[PubMed]
[CrossRef]
 
Peritogiannis  V;  Antoniou  K;  Mouka  V  et al:  Duloxetine-induced hypomania: case report and brief review of the literature on SNRI-induced mood-switching.  J Psychopharmacol 2009; 23:592–596
[PubMed]
[CrossRef]
 
References Container
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References

Chang  CH;  Chen  SJ;  Chang  CH  et al:  Manic episode following a combined treatment of repetitive transcranial magnetic stimulation and venlafaxine.  J Neuropsychiatry Clin Neurosci 2010; 22:E18, E19
[PubMed]
[CrossRef]
 
Xia  G;  Gajwani  P;  Muzina  DJ  et al:  Treatment-emergent mania in unipolar and bipolar depression: focus on repetitive transcranial magnetic stimulation.  Int J Neuropsychopharmacol 2008; 11:119–130
[PubMed]
[CrossRef]
 
Arul-Anandam  AP;  Loo  C;  Mitchell  P:  Induction of hypomanic episode with transcranial direct current stimulation.  J ECT 2010; 26:68–69
[PubMed]
[CrossRef]
 
Peritogiannis  V;  Antoniou  K;  Mouka  V  et al:  Duloxetine-induced hypomania: case report and brief review of the literature on SNRI-induced mood-switching.  J Psychopharmacol 2009; 23:592–596
[PubMed]
[CrossRef]
 
References Container
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