From depression to hypomania: antidepressant-triggered switching in a bipolar patient with phenotypic mitochondrial features

Parinda Parikh; Rithika Narravula; Namitha M. Mathew; Eunsaem Lee; Sagar Dua; Isa E. Gültekin; Mina Oza

doi:10.18203/2394-6040.ijcmph20254458

Authors

Parinda Parikh Department of Psychiatry, Weill Cornell Medical College, White Plains, USA
Rithika Narravula University of Pittsburgh, PA, USA
Namitha M. Mathew Amala Institute of Medical Sciences, Thrissur, Kerala, India
Eunsaem Lee Department of Psychiatry, Hangil Hospital, Jeonju, South Korea
Sagar Dua West Delhi Psychiatric Centre, Delhi, India
Isa E. Gültekin Ankara University Medical School, Ankara, Turkey
Mina Oza 2ND ARC Associates, White Plains, USA

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20254458

Keywords:

Bipolar disorder, Antidepressant induced mania, Mitochondria, Mitochondrial dysfunction

Abstract

Antidepressant-induced mania (AIM) is a recognized complication in bipolar disorder, particularly in patients with neurobiological vulnerabilities. Mitochondrial dysfunction, which impairs neuronal energy metabolism, has been implicated in both bipolar pathophysiology and antidepressant sensitivity. We report the case of a 25-year-old woman with bipolar disorder who presented with a two-month history of worsening depressive symptoms. Her medical history included exercise intolerance since adolescence, recurrent migraine headaches. Given her persistent low mood, sertraline was initiated. Within 10 days, she developed pressured speech, decreased need for sleep, and increased goal-directed activity, consistent with hypomania. The antidepressant was discontinued. She remains stable on lurasidone with maintenance ketamine infusions every 7 weeks. This case illustrates the potential role of mitochondrial dysfunction as a biological amplifier for polarity switching in bipolar disorder. Systemic features of mitochondrial impairment may warrant greater caution with antidepressant use, with emphasis on mood stabilizer-centered regimens and close monitoring for early signs of mood elevation.

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