Escitalopram-associated mania in a child.

119 ANTIDEPRESSANT INCLUDING selective serotonin uptake inhibitor (SSRI)-associated mania has been well documented in the literature. Escitalopram induced mania has been reported in an adult with unipolar depressive disorder (Prapotnik et al. 2004). Also Pravin et al. (2004) described an adolescent with severe major depression and a family history of depression who developed mania with concomitant use of citalopram and escitalopram. But a recent study that examined the efficiency and safety of escitalopram (10–20 mg/day) in children and adolescents with depression revealed one patient with manic reaction treated with placebo but none with escitalopram (Wagner et al. 2006). Here we present a prepubertal child who developed mania under escitalopram treatment with no personal and family history of mood disorder. An 11-year-old girl was referred to our outpatient clinic with complaints of restlessness, shortness of breath, running heart, and sleep disturbance for about a year. She was reported to be a fearful child, having nightmares about losing her parents, being afraid of staying at home and going to school alone. She had excessive worry about her school performance and future events. She appeared to be tense and anxious, and showed no signs of elevated or depressed mood, psychosis, hyperactivity or compulsive behavior. The Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version (K-SADS-PL) (Kaufman et al. 1997) was conducted and the final diagnosis of generalized anxiety disorder was given according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria (American Psychiatric Association 1994). She was started on escitalopram 10 mg/day. On the 7th day of the treatment, she was brought to the emergency clinic with symptoms of excessive talking, uttering curses with sexual content, flight of ideas, hyperactivity, sleeplessness, singing and dancing, all of which appeared within 24 hours. In the psychiatric examination, euphoric mood, pressured speech, psychomotor excitation and visual hallucinations with dog and cat figures were detected. Complete blood count, biochemical analysis, toxic screening, thyroid function tests, neurological assessment, and cranial magnetic resonance (MR) revealed no abnormality. She used no drugs other than escitalopram in the prescribed dose in the last month. She was diagnosed as suffering from a manic episode precipitated by escitalopram treatment and given an intramuscular injection of olanzapine 10 mg once and received no other medications afterward. She showed complete recovery from her manic symptoms within 3 days after the discontinuation of escitalopram. She has been followed for 16 weeks without medication and no symptoms of mania have emerged.