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Opioids may induce mania in bipolar patients: no explanation behind the trigger.

PITTSBURGH -- If a patient taking opioid analgesics turns hypomanic or manic, he or she may have an undiagnosed bipolar disorder, Dr. Charles Schaffer said in a poster presentation at the Fifth International Conference on Bipolar Disorder.

There's no explanation for the mechanism of action that triggers the mania, said Dr. Schaffer, a psychiatrist in private practice in Sacramento. He conducted a study to determine how bipolar patients would respond to opioid analgesics.

In a retrospective clinical survey, 33 of 45 consecutive adult bipolar patients who took opioids were compared with 14 control adults without mood disorders who took opioids. Nine of the bipolar patients (27%) developed hypomanic or manic symptoms after taking opioids, but none of the controls developed such symptoms, Dr. Schaffer said. The mood-elevating effects broke through the antimanic medications taken by four of the nine patients, and two of the patients took opioid analgesics for an antidepressant effect while they experienced active depression symptoms, he added.

Seven of the nine patients who developed symptoms took the opioid hydrocodone (Vicodin), one took morphine, and one took tramadol. Most of the patients were taking opioids for relief of physical pain. Although exact dosage information was limited by patient recall, seven patients were taking opioids as needed, while two were taking opioids daily.

The presence of DSM-IV hypomanic and/or manic symptoms and a score of 6 or 7 on the Clinical Global Impressions-Bipolar Scale determined a manic response.
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Title Annotation:Adult Psychiatry
Author:Splete, Heidi
Publication:Clinical Psychiatry News
Article Type:Brief Article
Date:Oct 1, 2003
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