{'fraction_non_alphanumeric': 0.027581567440296, 'fraction_numerical': 0.0053817692566431215, 'mean_word_length': 5.234800838574423, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Bupropion-induced hypomania in a patient with unipolar depression.

Antidepressant-induced switch episodes of hypomania/mania can occur in patients with bipolar depression [1]. Such switch episodes occur much less commonly in unipolar depression [2]. Although all antidepressants have been implicated, bupropion is thought to carry much less risk [3,4]. Contrary to this belief, we present a case that highlights bupropioninduced hypomania in a patient with unipolar depression. This is, to our knowledge, the first such reported case. The patient, a 31-year-old woman, had been under our treatment due to a 3 month history of depressed mood, impaired concentration, worthlessness, disturbed sleep and loss of appetite. Past history was suggestive of chronic depression successfully treated with antidepressant monotherapy. No previous trial of mood stabilizers was reported. The patient admitted to two previous suicide attempts but denied any current suicidal thoughts. The patient did not report any previous episode of hypomania/mania. Historically or at the time of assessment there were no delusions or hallucinations. The patient had an extensive family history of psychiatric problems. Her biological mother and sister as well as all of her children were suffering from unipolar depression. There was no family history of bipolar illness. General physical examination and all relevant laboratory investigations including thyroid function were within normal limits. The patient was diagnosed with unipolar depression and started on bupropion (Wellbutrin XL, GlaxoSmithKline, Memphis, TN, USA) 150 mg day . When seen at follow up after 3 weeks of treatment, the patient reported significant improvement in her symptoms of depression. She reported euthymic mood, improvement in concentration, no anhedonia and some improvement in sleep and appetite. The patient reported no side-effects from medications. But 5 weeks after starting bupropion the patient reported elated mood, increased energy level, decreased need for sleep, and racing thoughts. During assessment the patient seem restless and was pacing all around the interview room (psychomotor agitation). She reported no grandiose or other delusions but scored 9 on the Altman Self-Rating Mania Scale [5] (score 6 suggests hypomania or mania), and the patient met DSM-IV criteria for hypomania. We decided to stop bupropion. Two weeks later the hypomanic symptoms subsided (Altman Self-Rating Mania Scale score 5) and the patient’s mood reverted to euthymia. It was obvious that the patient had had an episode of medication-induced hypomania. On follow up the patient continues to be treated for unipolar depression only, with a history of medication-induced hypomania. In light of the aforementioned findings we emphasize the need for prescribers to maintain a high index of suspicion regarding medication-induced hypomania, even with regard to bupropion, and even when the patient has unipolar depression only.