Duloxetine-induced hypomania: case report and brief review of the literature on SNRIs-induced mood switching

J Psychopharmacol. 2009 Jul;23(5):592-6. doi: 10.1177/0269881108089841. Epub 2008 Jun 18.


Manic switching during antidepressant treatment has been reported with every class of antidepressant drugs. Serotonin-noradrenaline reuptake inhibitors (SNRIs) have been increasingly used for the treatment of unipolar and bipolar depression and are well tolerated and sufficiently effective because of their dual mechanism of action. A case of duloxetine-induced hypomania in a non-bipolar patient is presented, and a brief review of all cases of SNRIs' induced mania and hypomania has been carried out. The available data suggest that SNRIs, especially venlafaxine, can induce mood switching in patients with bipolar depression and in certain patients with unipolar depression, but the potential of duloxetine and milnacipran to induce manic or hypomanic symptoms cannot be disregarded. Switching appears to be dose-related and treatment initiation with lower doses and upward titration when needed may be preferable in selected cases and may help minimizing the risk of mood switching.

Publication types

  • Case Reports

MeSH terms

  • Bipolar Disorder / chemically induced*
  • Depressive Disorder / drug therapy
  • Dose-Response Relationship, Drug
  • Duloxetine Hydrochloride
  • Female
  • Humans
  • Middle Aged
  • Selective Serotonin Reuptake Inhibitors / administration & dosage
  • Selective Serotonin Reuptake Inhibitors / adverse effects*
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Thiophenes / administration & dosage
  • Thiophenes / adverse effects*
  • Thiophenes / therapeutic use


  • Serotonin Uptake Inhibitors
  • Thiophenes
  • Duloxetine Hydrochloride