Bipolar Mania Rapidly Induced by Low Dose Pramipexole in a Japanese Bipolar I Disorder

Hiroaki Ono

Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo, Japan Kitamatsudo-Medical Clinic, Japan

^*Correspondance to: Hiroaki Ono 

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Abstract:

Dopaminergic agonists are widely used in the treatment of Parkinson's disease and bipolar disorder. Psychosis induced by dopaminergic agonists in Parkinson’s disease has been reported frequently, but cases of mania induced by dopaminergic agonist are rare. Here we report the case of bipolar mania induced by pramipexole, which was used for the treatment of Parkinson's disease. The patient was a 59-year-old male with bipolar disorder type I. He presented with an exacerbated hand tremors. Physical examinations revealed that he presented symptoms of Parkinson's disease (i.e., hand tremors, stiffness, rigidness, and postural reflex impediment). After using a week of pramipexole (0.25 mg d-1), his hand tremors improved markedly. However, at the same time, he developed hyperthymia, irritability, aggression, hyperlogia, and the flight of ideas. He was diagnosed as bipolar mania. Most manic symptoms were resolved within 4 weeks by using valproic acid, olanzapine, and levomepromazine. Our case is unique in that pramipexole induced bipolar mania rapidly (i.e., within a week) even in minimum doses (i.e., 0.25 mg d-1). Dopaminergic agonists are often used to treat bipolar disorder, for example, in cases complicated with Parkinson's disease and cases of refractory/recurrent bipolar depression. When dopaminergic agonists are used in patients with bipolar disorder, as in this case, mood should be assessed and checked for signs of bipolar mania.

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Cite the Article:

Ono H. Bipolar Mania Rapidly Induced by Low Dose Pramipexole in a Japanese Bipolar I Disorder. Clin Case Rep Int. 2020; 4: 1168.